THE  LIBRARY 

OF 
THE  UNIVERSITY 

OF  CALIFORNIA 
LOS  ANGELES 


CAST  GOLD  AND  PORCELAIN  INLAYS 


TECHNIC  AND  SCOPE 


OF 


CAST  GOLD  AND  PORCELAIN  INLAYS 


WITH  A  CHAPTER  ON 

ENDOCKINODONTIA,   OR  THE   DUCTLESS   GLANDS— 
THEIR    EXPRESSION    IN    THE    IIUMAX    MOUTH 


I ',  Y 
HERMAN'   E.  S.  CHAYES,  D.D.S. 

NEW  YORK  CITY 


With  372  Illustrations 


ST.  LOUIS 
C.  V.  MOSBY  COMPANY 

1920 


COPYRIGHT,  1918,  BY  C.  V.  MOSBY  COMPANY 


Press  of 

C.   V.  Mosby  Company 
St.  Louis 


U 

o 

aw* 


IN  MY  FIRM  CONVICTION  THAT  THE 
TRIALS  AND  TRIBULATIONS  WHICH  HARASS 
Us  ARE  BUT  AN  EVIDENCE  OF  OUR  ULTI- 
MATE VICTORY  OVER  THE  EVILS  WHICH  AT 
PRESENT  ENSLAVE  Us,  THIS  BOOK  Is  AF- 
FECTIONATELY DEDICATED  TO  MY  FEL- 
LOWMEN. 


PREFACE 

The  introduction  to  this  book  was  written  in  the  early  part 
of  1913,  before  tlie  people  of  the  world  even  dreamed  of  the  ter- 
rible catastrophe  which  has  since  overtaken  three  continents  and 
threatens  to  force  the  remaining  ones  into  the  horrible  and 
voracious  whirlpool  of  an  uncivilized  warfare. 

I  am  including  this  introduction  in  spite  of  pressure 
brought  to  bear  upon  me,  because  I  feel  that  a  new  order  of 
things  in  general  is  about  to  appear  in  the  world  and  I  feel  im- 
pelled to  do  what  I  can  to  speed  the  day  of  clearer  thinking, 
greater  tolerance,  and  more  virile  idealism. 

It  holds  something  for  the  man  or  woman  who  will  read  it 
with  the  same  sincere  desire  and  regard  for  truth  and  equity 
and  justice  which  the  author  felt  himself  possessed  of  when  he 
wrote  it. 

I  want  to  at  this  time  pay  my  respects  and  acknowledge  my 
obligation  to  the  many  writers  of  the  many  helpful  hooks  I  may 
have  quoted  in  this  volume,  and  express  my  thanks  to  the  many 
men  in  my  profession  who  have  labored  and  are  laboring  in  the 
same  or  similar  pursuits,  and  whose  work  has  been  helpful  to 
me  to  no  small  degree. 

I  want  to  acknowledge  my  deep  obligations  and  register  a 
pupil's  sincere  affection  for  my  dear  friend  and  teacher,  Dr. 
Joseph  Fraenkel,  of  Xew  York,  for  the  many  interesting,  help- 
ful, and  clarifying  hours  of  instruction  he  unselfishly  devoted 
to  me  and  to  many  others,  and  which  have  made  me  familiar 
with  a  new,  a  higher,  a  clear,  sane  conception  of  the  physiologic 
and  the  morbid  processes  which  affect  living  beings  and  things. 

My  thanks  to  my  friend  Dr.  Chas.  G.  Taylor,  an  associate 
of  Dr.  Fraenkel,  for  his  measure  of  helpfulness  in  the  correct 
interpretation  of  the  functions  of  the  endocrines  in  their  asso- 
ciation with  the  dental  apparatus.  My  thanks  to  Dr.  J.  O.  Lief 
who  kindly  waded  through  the  entire  manuscript  to  formulate 
the  questions  at  the  end  of  each  chapter. 

Manv  thanks  to  all  mv  friends  who  have  stood  hv  me  and 

V  t  */ 

9 


10  PREFACE 

encouraged  me.  To  the  officers  and  members  of  the  Chayes 
Dental  Club  whose  loyalty  I  cherish  and  rejoice  in,  whose  ideal- 
ism I  admire  and  approve  of,  and  whose  success  is  my  ardent 
desire. 

Last,  but  not  least,  I  wish  to  express  my  sincere  appre- 
ciation and  thanks  to  my  wife  who  has  been  a  source  of  genuine 
inspiration. 

H.  E.  S.  CHAYES. 

New  York  City. 


CONTENTS 


CHAPTER     I 

INTRODUCTION 

Sequence  of  Thought  and  Its  Value  in  Teaching,  21 ;  The  Chief  Factors  Induc- 
ing Coordinate  Mental  Efforts,  24;   Some  Rational  and  Acceptable  Conclusions,  48. 

CHAPTER     II 

THE  FUNCTIONS  OF  THE  TEETH 

The  Functions  of  the   Teeth,   52;    Passive   Reciprocal  Functions,  58;    Active 

Reciprocal   Functions,  58. 

CHAPTER     III 

THE  CAST  GOLD  INLAY 

The  Cast  Gold  Inlay,  62. 

CHAPTER     IV 

SELECTION  OR  ELECTION  OF  THE  CASE  PRESENTING 

A  CAVITY 

The  Selection  or  Election  of  the  Case  Presenting  a  Cavity,  04. 

CHAPTER     V 

CAVITY  PREPARATION 

Geometric  Landmarks  of  Teeth,  65;   Hygienic  Landmarks  of  the  Teeth,  69; 
Cavity  Preparation,  76. 

CHAPTER     VI 

THE  MESIO-DISTO-OCCLUSAL  CAST  GOLD  INLAY 

The   Cast   Gold   Complement   for  a   Tooth   Presenting   a   Alesio-Disto-Occlusal 
Cavity,  120;  Cavity  Preparation,  121. 

CHAPTER    VII 

THE  SELECTION  OF  THE  PROPER  WAX 

The  Selection  of  the  Proper  Wax,  127. 

11 


12  COXTKXTS 

CHAPTER     VIII 

MAKING  AND  CARVING  OF  THE  WAX  INLAY  BY  THE  USE  OF 
THE  DIRECT  METHOD 

Making  and  Carving  of  the  Wax  Inlay  by  the  Use  of  the  Direct  Method,  131. 
CHAPTER     IX 

TAKING  AN  IMPRESSION  OF  THE  CAVITY  AND  MAKING    A 
DIE  FOR  PROCEDURE  BY  THE  INDIRECT  METHOD 

Taking  an  Impression  of  the  Cavity  and  Making  a  Die  for  Procedure  by  the 
Indirect  Method,  139;  The  Making  of  the  Amalgam  Die,  148. 

CHAPTER     X 

THE  INVESTMENT,  OR  REFRACTORY,  COMPOUND 

The  Investment,  or  Refractory,  Compound,   158;    Silicon,   160;    Calcium,   162; 
Magnesium,  162;  Alumina,  163. 

CHAPTER     XI 

THE  DRYING  OUT  OF  THE  MOLD  AND  THE  BURNING  OUT  OF 

THE  WAX  MODEL 

The  Drying  Out  of  the  Mold  and  the  Burning  Out  of  the  Wax  Model,  173. 

CHAPTER     XII 

THE  CASTING  OF  THE  MOLTEN  METAL  INTO  THE  MOLD 

The  Casting  of  the  Molten  Metal  into  the  Mold,  178. 

CHAPTER     XIII 

THE  METALS  FOR  THE  INLAY  WORKER 

The  Metals  for  the  Inlay  Worker,  182. 

CHAPTER     XIV 

THE  CASTING  OF  THE  MOLTEN  METAL  INTO  THE  MOLD  AND 

A  CONSIDERATION  OF  THE  VARIOUS  MACHINKs 

EMPLOYED 

The  Casting  of  the  Molten  Metal  into  the  Mold  and  a  Consideration  of  the 
Various  Machines  Employed,  187. 


COXTKXTS  13 

CHAPTER     X  V 

THE  CLEANSING  OF  Till-:  CASTING  IN  II  VDROPLUORIC  ACID 
AND   IN   A   SODIT.M    UlCAUBnNATE    BATH 

The  Cleansing  of  tlio   Casting   in   Hydrofluoric   Acid   and   in   a   Sodium  Bicar- 

Imiiate   I'.atli.  lid'.). 

CHAPTKK      XVI 

RE.MnVAL  OK  Till-]  EXCESS  OF  METAL.  THE  POLISHING.  AND 
Till-:   CEMENTATION  OF  THE  INLAY 

Removal   of  the  Excess  of  Metal,   the  Polishing,   and   the   Cementation   of  the 
Inlay.  I'l.",. 

CHAPTER     XVII 

THE  SPLINTING  OF  LOOSE  TEETH  BY  MEANS  OF  INLAYS 

The  Splinting  of  Loose  Teeth  by  Means  of  Inlays,  218. 

CHAPTER     XVIII 

E  XTEXS I  VI-:    RESTORATIONS  OF  OccLfSAL  BALANCE  BY 
MEAXS  OF  GOLD  INLAYS 

Extensive  Restorations  of  Occlusal  Balance  by  Means  of  Gold  Inlays,  236; 
Construction  of  the  Splint,  245. 

CHAPTER     XIX 

GOLD  INLAYS  AND  THE  SILICATES  OR  PORCELAIN 

Gold  Inlays  and  the  Silicates  or  Porcelain,  269. 

CHAPTER     XX 

THE  PHENOMENA  OF  LIGHT  AND  COLOR 

The  Phenomena  of  Light  and  Color,  302;  Reflection  and  Refraction  and  Ab- 
sorption, 304. 

CHAPTER     XXI 

THE  PORCELAIN  INLAY 

The  Porcelain  Inlay,  322;  Cavity  Preparation,  328. 

CHAPTER     XXII 

ENDOCRINODONTIA,  OR  THE  DUCTLESS  GLANDS— THEIR 
EXPRESSION  IN  THE  HUMAN  MOUTH 

Endocrinodontia,    or   the   Ductless   Glands — Their   Expression    in    the   Human 
Mouth,  359. 


ILLUSTRATIONS 


TIG.  PAGE 

1.   Diagram    showing   reciprocal    functions   of   the   teeth 59 

l'.  Showing  diaiirammatically  the  various  surfaces,  line  angles,  and  cutting,  or 

point,    angles   of    incisor    teeth 66 

3.  Showing  diagranmiatically  the  surfaces,  line  angles,  and  cutting,  or  point, 

angles   of   a   cuspid 66 

4.  Showing  diagranmiatically  surfaces,  line  angles,  and  point  angles  of  bicus- 

pids   and    molars 66 

5.  Immune  areas  of  anterior  teeth  and  susceptible  areas 70 

(5.  Immune  areas  of  posterior  teeth ...      70 

7.  Immune  areas  and  susceptible  areas  of  posterior  teeth 70 

x.   A  set  of  chisels  used  by  the  author  in  tooth  structure  cutting 72 

9.  Cross  section  of  molar  tooth  illustrating  prepared  cavity  and  bevel     ...     74 

10.  Cross  section  of  molar  showing  a  disto-occlusal  cavity 74 

11.  Longitudinal  section  of  molar,  showing  mesial  and  distal  planes     ....      78 

12.  Cross   section   of   bicuspid 78 

13-17.  Five  views  of  an  upper  first  bicuspid  presenting  a  simple  occlusal  cavity, 

and  the  cast  gold  inlay  made  for  it .80 

18-24.  Seven  views  of  a  first  right  lower  bicuspid  presenting  a  compound  disto- 

occlusal  cavity  involving  also  the  cervical  portion  of  the  buccal  wall, 

restored  with  a  cast  gold  inlay  disto'-occlusally,  and  a  porcelain  inlay 

buccally 82 

-o -:\'2.  Eight  views  of  an  upper  first  bicuspid  presenting  a  mesio-occlusal  cavity, 

and  the  restoration  made  for  it 84 

33-37.  Five  views  of  a  lower  second  bicuspid  presenting  a  mesio-disto-occlusal 

cavity,  and  the  inlay  made  for  it 86 

38-46.  Nine  views  of  a  mesio-occlusal  cavity  in  a  first  lower  bicuspid,  and 

restoration  made  for  it 88 

47-54.  Eight  views  of  a  lower  second  bicuspid  presenting  a  mesio-disto-occlusal 

cavity,  and  the  restoration  made  for  it 90 

55-60.  A  first  lower  molar  presenting  a  labio-  or  bucco-occlusal  cavity,  and  the 

cast  gold  inlay  made  for  it 92 

61-68.  A  lower  molar  presenting  a  disto-occlusal  cavity,  the  lower  half  of  the 

buccal  wall  being  involved  to  the  full  mesial-distal  extent  ....  94 
69-78.  A  disto-occlusal  cavity  in  an  upper  molar  and  a  disto-buccal  cavity  in  the 

same  tooth.    Two  cast  gold  inlays  for  the  respective  cavities  and  three 

views  of  the  finished  operations 96 

79-86.  A  mesio-disto-occlusal  cavity  in  an  upper  molar,  also  a  buccal  cavity  in 

the  same  tooth 98 

87-88.  Two  illustrations  of  teeth  worn  down  by  attrition,  restored  by  means  of 

the  cast  gold  inlay,  imitating  the  conditions  of  adjacent  teeth  .  .  100 
89-94.  Loft  first  lower  molar  presenting  deficiency  of  occlusal  third.  Views 

illustrating  preparation  of  cavity  and  restoration  made  for  it  in  the 

shape  of  a  cast  gold  inlay 102 

15 


JU.rSTItATIOXS 

PAGE 


no. 
95-102.  A    complex    cavity    in    an    upper    molar    involving    every    surface    of 

the   tooth,  and   cast   gold   inlay   made   for   it      .......      104 

103-111.  Nine   views  of  a   second  lower   molar   present  ing   a   mesio-disto-oc- 

clusal-bnccal    cavity    and    two   interlocking   cast    gold    inlays    made 


for    it 


100 


112-119.  A  mesio-occlnsal-palatal  cavity  in  an  upper  molar  restored  by 

means  of  a  cast  gold  inlay 10S 

120-127.  Eight  views  of  a  mesio-disto-occlusal  cavity  in  an  upper  second  bi- 
cuspid, and  the  cast  gold  inlay  made  for  it HO 

128-135.  Eight  views  of  a  complex  cavity  in  an  upper  second  bicuspid,  and 
the  restoration  made  for  it  in  the  shape  of  a  cast  gold  inlay.  The 
labial  portion  of  this  inlay  has  been,  in  turn,  inlayed  with  synthetic 
porcelain . 

136.  Stress  index  for  upper  teeth 

137.  Stress  index   for  lo.wer  teeth 

138-139.  Buccal  and  lingual  views  of  a  case  of  nearly  normal  occlusion      .      117 

140.  The  first  cut  after  the  decay  has  been  removed  in  the  preparation  of  a 

mesio-occlusal-distal  cavity  in  a  molar 122 

141.  The  second   cut,   removal   of   the"   mesial   wall,   to   provide   for   the   onlay 

part  of  the  inlay     ....  1-- 

142.  The  third  cut.     The  removal  of  the  distal  wall  to  provide  for  the  onlay 

part    of    the    inlay 123 

143.  The  final  cut.     The  bevel  upon  the  occlusal  surface  continuous  with  the 

mesio  biiccal,     disto-buccal,     mesio-lingual,     and     disto-lingual     guides 

of  the  cavity,  which  guides  are  beveled  outward 123 

144.  The  wax  inlay  made  for  the  mesio-occluso-distal  cavity 124 

145.  The  finished  inlay  in  position  upon  the  tooth 124 

146.  The    Taggart    automatic    wax    warmer 132 

147.  A  glass  of  water  with  cork  and  pins  for  submerging  wax      ....      134 

148.  A  spatula,  a  set  of  right  and  left  and  straight  flat  burnishers,  lancets. 

right    and    left    carvers,    and    hand    drills 137 

149.  Method  of  making  a  handy  matrix 141 

150.  Illustrating  a  handy  matrix   in  position   upon   a  molar 141 

151-152.  Hinged  trays  for  taking  correct  impressions  of  mesio-disto-occlusal 

cavities   and   teeth   upon  which  they  present 144 

153.  Disto-occlusal   cavity    tray 144 

154.  Mcsio-occlusal  cavity   tray 144 

155.  Hinged    tray    for   anterior    teeth 144 

156.  Hinged    tray    in     position 145 

157.  Hinged    tray    in    closed    position 145 

158.  Complete  impression  of  tooth  and  cavity  embedded  in  plaster  impres- 

sion of  adjacent  teeth,  ready  for  the  packing  of  amalgam  die     .      .      147 

159.  Complete  impression  of  tooth  and  cavity,  removed  from  the  mouth     .      147 

160.  Model  presenting  a  view  of  amalgam  replica  of  tooth  requiring  restora- 

tion in  correct  relation  to  adjacent  teeth 150 

161.  Model  lubricated  with  mixture  of  castor  oil  and  glycerine     ....  150 

162.  Occluded    models    of    case    requiring    restoration 151 

163.  The  Taggart  automatic  investment  mixer  attached  to  a  lathe     .  168 


ILLUSTRATIONS  17 
FIG.                                                                                                                                                                                           PAGE 

KV4.  The  Taggart  automatic  invcstniont  mixer  attached  to  its  own  motor,  a 
clock  with  an  alarm  which  rings  when  the  compound  is  ready  for 

use 168 

KM.  The  Taggart  mixer  as  used  in  the  author's  laboratory 170 

166.  Taggart  automatic   (gas)   burner  for  removing  wax  pattern  from  mold  174 

l'i~.   1'lat check  furnace  closed,  showing  flue,  or  chimney 175 

1<>8.  The  platcheck   furnace  for  burning  out  the  wax 176 

1»>9.  The   charcoal  block  with  a  depression  in  it  to  act  as  a  crucible     .      .  183 

MO  A.  The  Elgin  vacuum  casting  machine  and  Masks 192 

MOB.  Same  machine  as  in  Fig.  170.4,  ready  for  casting 192 

171.  Taggart  machine   with  flask  in  position  on  its  base 201 

I?!'.  The  Taggart  machine  raised  to  permit  the  use  of  a  number  of  sizes  of 

larger    flasks 202 

I".'!.  To  the  right  is  a  view  of  a  small  Taggart  flask  and  its  crucible  former 

which    holds    the    sprue    wire 204 

174.  A  special  flask,  barrel-shaped 204 

17-").  Acid  cup,   support,  and  stopper   for  hydrofluoric   acid 210 

17»i.   showing  the  parallelometer  wrench  in  position  on  locking  stud      .      .      .  219 
177.   Measuring    posts    on     parallelometer     in     position     for    all    measurements 

from   (5   mm.  iip  to  and  including   10   mm 219 

17v    Measuring  posts  in   same  clamps  as  in  preceding  cut,  but  with  the  dis- 
tance  between   them  increased  to   10  mm 220 

17!'.   Showing  position  of  measuring  posts  for  all  measurements  from  10  mm. 

up  to   and   including  25   mm 220 

IMI.    Measuring    posts    in    same   clamps    as    in    Fig.    179,    but    with   the   distance 

increased     to    40     mm 221 

181.  When  the  distance  to  be  measured  exceeds  40  mm.,  the  parallelometer  is 

reversed  and  the  measuring  posts  are  placed  in  the  clamps  as  shown  221 

182.  Measuring   posts   in    same    damps    as    in    Fig.    181,    but   the    distance   has 

been  increased  to  55  mm 222 

183.  The  above  cut  shows  where  the  parallelodrill  should  be  oiled     .      .      .  223 
JS4.   Distance    established    between    cuspids 224 

185.  Showing  the  operation  of  the  parallelodrill  reaming  out  two  root  canals 

in     the     two     upper    cuspids    to     receive     the     split    pin     and     tube 

attachments 224 

186.  Showing  the  method  of  transferring  the  distance  from  the  parallelom- 

eter   to    the   parallelodrill 226 

187.  Distance    established    between    cuspid    and    lateral    on    opposite    side    of 

the     arch 228 

188.  Distance  established  between  right  cuspid  and  left  lateral     ....  228 

189.  Distance  established  between  left  cuspid  and  right  central     .      .      .  230 

190.  Distance  established  between  right  cuspid  and  left  central     ....  230 

191.  Finished  splint   ready  to  be  inserted 232 

192.  A  case  of  extensive  restoration 237 

193.  A  view  of  a  splint  made  for  a  case  of  extensive  restoration     ....  247 

194.  Another  view  of  the  splint  shown  in  Fig.   193,  which,  when  it  was  first 

made  and  worn,  covered  all  the  anterior  portion  of  the  jaw,  as  well 

as  the  part  now  occupied   by  it "  247 


18  ILLUSTRATIONS 

FIG.  PAGE 

195.  The  splint  in  position  on  the  model 247 

196.  An   occlusal   view   of  the   models   of   a   case,   showing   the   terrible   havoc 

wrought  by  neglect 252 

197.  The  model  of  the  upper  teeth  of  case  after  six  months'  treatment     .     2.12 

198.  The  lower  model  model  showing  clearly  the  rebuilding  of  the  anterior,  and 

sonic  of  the  posterior,  teeth  by  moans  of  the  cast  gold  inlay  and 
cast  base  crowns 252 

199.  The  upper  and  lower  models  in  occlusion 252 

200.  An  occlusal  view  of  a  finished  case  of  extensive  restoration  by  means  of 

cast   gold   inlays   and   two   upper   bridges 254 

201.  A  side  view  of  the  same  case — upper  and  lower  models  in  occlusion     .  254 

202.  Diagram   of   face   showing   normal   proportions 255 

203.  Chart    showing    geometrical    construction    of    crown 256 

204.  Illustrating   determination   of   proximal   contact   between   molars     .      .  258 

205.  (1)  A  horizontal  section  representing  the  occlusal  plane  of  the  middle 

third  of  an  upper  second  bicuspid.  (2)  A  horizontal  section  repre- 
senting the  occlusal  plane  of  the  middle  third  of  a  lower  second 
bicuspid .  .  .  259 

206.  Showing  how  perfectly  occlusal  surfaces  may  be  carved  in  the  wax  and 

reproduced  by  means  of  the  casting  process 260 

207-209.  Three  illustrations  of  beautiful   occlusal   surfaces 263 

210.  Note  the  two  illustrations  on  the  lower  portion  to  the  left,  with  their 

inefficient  occlusal  surfaces,  and  compare  the  four  other  illustra- 
tions with  their  definite  sulci  cusps,  and  fissures 264 

211.  Showing    the    ways    in    which    attrition    manifests    itself     in     different 

types 265 

212.  Another  type  of  the  result  of  attrition 265 

213-218.  A  case  of  extensive  restoration 267 

219-225.  Gold  inlays  and  porcelain  or  the  silicates.    A  number  of  views  of  a 

lower   central    fractured    in    a    fall 270 

226-232.  A  number  of  views  of  a  lower  lateral  restored  by  means  of  a  cast 

gold  inlay  and  synthetic  porcelain 272 

233-239.  A  number  of  views  of  a  lower  lateral  involved  by  fracture  and 
decay  restored  by  the  use  of  a  gold  inlay  in  conjunction  with 
silicate  cement — root  filled 274 

240-246.  A  number  of  views  of  a  lower  lateral  fractured  in  a  fall.  Extir- 
pated pulp 278 

247-253.  Seven  views  of  a  lower  cuspid,  presenting  another  type  or  restora- 
tion, also  a  combination  cast  gold  inlay  and  porcelain  insert  .  .  .  280 

254r260.  Seven  views  of  a  broken-down  cuspid  restored  with  a  cast  gold  in- 
lay and  a  porcelain  insert 282 

261-267.  A  left  upper  lateral  presenting  a  mesio-labio-linguo-incisal  defi- 
ciency restored  to  use  and  cosmetic  acceptablencss  by  a  cast  gold 
inlay  and  synthetic  porcelain 284 

268-275.  Views  of  a  right  upper  central  presenting  a  large  mesio-labio-linguo- 
incisal  deficiency,  restored  to  use  annd  cosmetic  acceptableness  by 
a  cast  gold  inlay  and  porcelain  insert 288 


II.I.rSTItATFONS  19 

FIG.  PAGE 

276-282.  Views  of  a  left  upper  central  presenting  a  mesio-disto-labio-incisal 
deficiency,  restored  to  use  and  cosmetic  acceptableness  by  a  cast 

gold  inlay  and  synthetic  porcelain  insert 290 

2H:!-2S9.  A  number  of  views  of  a  right  upper  central  presenting  an  eroded 
and  pitted  labial  surface,  a  mesio-  and  disto-proximal  cavity,  and  a 

lingual  enamel  surface  which  was  perfect,  as  was  the  incisal  edge  292 

290-296.  Seven  views  of  another  type  of  restoration  in  an  upper  cuspid     .      .  296 

297-303.  Seven  views  of  a  right  upper  cuspid  presenting  a  prehenso-labio- 

linguo-mesial  deficiency 298 

304.  Diagram    showing    refraction    of    light 307 

305.  Color      chart 316 

306.  Method  of  obtaining  a  separation  between  two  teeth  which  are  to  be 

inlayed 330 

307.  Method  of  separating  two  teeth  that   lean   towards  one  another      .      .  331 

308.  Manner  of  preparation  of  a  simple  cavity  for  a  porcelain  inlay     .      .  332 
309-311.  Foil  between  two  layers  of  goldbeater's  skin 333 

312.  A  set  of  eight  glass  burnishers  used  in  adapting  a  foil  matrix  to  the 

cavity  in  a  tooth  or  in  a  die 334 

313.  A    set    of    tantalum    instruments 334 

314.  A   small   platinum   tray 334 

315-318.  The  mixing  of  the  silver  amalgam 335 

319.  Foil  reposing  between  the  layers  of  goldbeater's  skin  and  the  applica- 
tion  of  the  hand   swager 336 

.'•L'".   A  disto-labial  cavity  in  a  central 338 

'.'•-}.  A  strip  of  platinoid  bent  at  an  obtuse  angle  and  perforated  so  as  to 
hold  the  compound  which  is  softened  in  the  flame  and  deposited 

upon  the  improvised  tray 338 

'.',-•2.  Carrying  tray  and  compound  between  the  teeth  and  forcing  the  ma- 
terial into  the  cavity 338 

323.  Lingual    view    showing   surplus   of    compound 338 

324.  Flat  straight  spatula  to  aid  in  placing  and  holding  impression  material  338 

l'<-~t.  A  labio-disto-lingual   cavity  in  a  lateral 339 

:'.Jii.  First   step   in  formation   of  tray 339 

.•.i'7.  Second   piece  of   metal 339 

328.  Improvised  slide  made  from  metal  shown  in  Fig.  327  to  fit  into  that 

shown    in    Fig.    326 339 

329.  Showing    completed     slide 339 

330.  Slide    carrying   compound    and    taking   impression    of    lingual    part    of 

cavity  and  all  of  distal  part 339 

331.  Slide  is  raised  and  the  impression  is  removed  from  the  tooth  in  a  lin- 

gual    direction 339 

332.  A   linguo-mesial    cavity    in    a    lateral 340 

333.  The     tray 340 

334.  The     impression 340 

335.  The  plastic  instruments  used   as  an   aid  to   project   the  compound  into 

the  cavity 340 

336-338.  Showing   cervical   cavity  in    a    cuspid,   the   partly  and  completely 

formed    tray 340 


20  ILLUSTRATIONS 

FIG.  PAGE 

339-341.  A  cervical  proximal  in  a  lateral  and  the  partly  and  the  com- 
pletely formed  tray  for  taking  impression 341 

342-346.  A  cervical  cavity  in  the  disto-labial  surface  of  a  molar,  the  partly 
and  the  completely  formed  tray  with  compound  in  position  on  the 
tooth,  and  the  impression  of  the  cavity 341 

347-351.  Same  as  shown  in  Figs.  340  to  349  on  opposite  side  of  the  arch     .      342 

352-354.  A  disto-occlusal  cavity  in  an  upper  molar,  the  partly  and  the  com- 
pletely formed  tray 342 

345-357.  A  labio-occlusal  cavity  in  a  molar,  the  partly  and  the  completely 

formed  tray 342 

358-360.  Another  type  of  disto-occlusal  cavity  in  a  molar,  the  partly  and  the 

completely  formed  tray  for  taking  impression 342 

361-362.  A  mesio-occlusal  cavity  in  a  lowar  molar  and  tray  for  taking 

impression  343 

363-366.  A  mesio-disto-occlusal  cavity  in  a  molar,  partly  and  completely 
formed  tray  for  carrying  the  compound  to  take  impression  of  this 
cavity 343 

367-370.  M.  O.  D.  cavity  in  bicuspid,  partly  and  completely  formed  tray  for 

taking  impression 344 

371.  A  handle  and  set  of  trays,  or  cups,  which  may  be  trimmed  to  suit  the 

case  to  facilitate  the  taking  of  impressions  of  various  cavities     .      .     344 

372.  The    Protector    of    David  378 


CAST  GOLD  AND  PORCELAIN  INLAYS 


CHAPTER  I 
INTRODUCTION 

SEQUENCE  OF  THOUGHT  AND  ITS  VALUE  IN 
TEACHING 

Usefulness,  in  the  broad  sense  of  the  word,  determines  the 
value  of  man  to  mankind.  Usefulness  is  the  purpose  of  this 
volume.  To  help,  to  improve,  to  simplify,  to  make  clear  obscure 
problems  in  this  particular  field,  will  mean  a  better  equipped 
profession,  and  hence  must  mean  betterment  to  the  great  human 
family  depending  upon  our  profession  for  their  comfort  and 
health. 

The  ambition  to  determine  definitely  for  the  profession  the 
best  mode  of  procedure  in  this  work,  to  coherently  elucidate 
innumerable  points  much  discussed  and  poorly  understood,  to 
delve  into  all  crevices  of  the  task,  to  throw  the  ray  of  sane, 
investigating  reason  into  the  shadows  of  the  recesses,  to  at- 
tempt and  succeed  in  proving  all  statements,  to  evade  noth- 
ing,— a  task  to  be  reckoned  with  but  worthy  of  the  best  efforts. 

To  best  serve  its  purpose,  this  volume  must  be  both  ele- 
mentary and  postgraduate,  and  no  apology  is  offered  if,  at  the 
beginning,  it  may  appear  to  the  student  that  he  is  reading  some- 
thing he  already  knows.  In  fact  it  is  best  to  make  it  plain  now, 
that  in  order  to  be  truly  useful,  and  readily  comprehended, 
leaching  must  always  begin  with  something  already  well  estab- 
lished in  the  student's  mind, 

In  attempting  to  teach  a  body  of  students  or  a  single  stu- 
dent anything  their  or  his  knowledge  of  which  is  deficient,  it 
is  conducive  to  best  understanding  to  start  at  first  principles. 

To  be  efficient,  a  textbook  must  be  so  written,  and  par- 
ticularly so  begun,  that  the  first  thing  to  greet  the  student 

21 


22  CAST   GOLD   AND    PORCELAIN    INLAYS 

mind  is  a  statement  of  a  fact,  or  a  fact,  already  fixedly  estab- 
lished in  his  mind;  and  from  that  lone  but  well-established  fact, 
all  avenues  of  research  and  investigation  and  proof  must  issue, 
to  converge  again  at  and  upon  a  perfectly  logical  and  hence 
well  dovetailed  conclusion.  Thus  it  is  seen  that  sequence  in  a 
textbook  plays  a  great  part  in  determining  how  valuable  the 
book  is  to  prove  to  the  student. 

We  must  have  then,  a  well-known  fact,  a  universally  known 
fact,  so  far  as  our  profession  is  concerned,  and  proper  sequence 
as  we  go  along;  and  we  must,  after  diverging  with  proper 
sequence  and  reaching  into  every  cranny  of  the  process,  so  con- 
verge our  thoughts  that  only  one,  and  that  the  proper  conclu- 
sion, is  possible. 

The  foregoing  qualities  will  make  up  a  useful  and  neces- 
sary textbook.  It  is  easy  for  the  student  to  prove  the  real 
value  of  this  book  to  himself  by  carefully  reading  it  from  the 
beginning,  and  if  he  reaches  his  conclusions  before  he  finishes 
the  last  chapter,  and  if  his  conclusions  coincide  with  the  con- 
clusions of  the  book,  then  the  correctness  of  its  logic  is  proved, 
and  its  value  as  a  textbook  becomes  apparent. 

If  I  were  to  attempt  to  teach  the  science  of  cooking,  I 
should  begin  my  textbook's  first  chapter  with  the  statement 
that  food  is  absolutely  essential  for  the  maintenance  of  the 
various  functions  that  make  up  the  activities  of  mankind,  and 
the  animal  as  well  as  the  vegetable  kingdoms.  That  would  be 
stating  a  fact  already  well  established  in  the  student's  mind, — 
so  fixedly  established  that  no  amount  of  argument  could  dis- 
lodge it.  From  that  lone  fact,  I  could  send  out  mental  expedi- 
tions of  investigation  into  e<very  phase  of  the  question,  covering 
food  as  to  kinds,  quantity  and  quality,  necessity  and  luxury; 
food  for  man,  for  animal,  and  for  vegetable:  and  we  could, 
after  discussing  all  of  them,  their  origin  and  preparation,  and 
reasons  thereof,  their  comparative  values  and  reasons  there- 
for, so  converge  my  findings  as  to  very  properly  feel  that  the 
very  best  thought  with  which  to  end  the  book  would  be  the  food 
thought. 

Were  I  to  attempt  a  work  on  architecture,  does  it  not  seem 
to  you,  the  neophyte,  the  uninitiated,  that  it  would  be  best  to 


SEQUENCE    OF    THOUGHT  Z6 

start  at  the  very  beginning  of  tilings  and  state  a  fact  already 
fixedly  established  in  your  neophytic  mind?  Suppose  then, 
I  were  to  say  that  man  is  poorer  than  animal  in  brute  force, 
and  richer  than  the  animal  in  intellect;  and  that  even  prehistoric 
man  had  a  cave  to  live  in,  to  house  him  and  his  descendants: 
that  would  be  stating  a  simple  and  true  fact,  already  well  estab- 
lished in  the  student's  mind  (in  any  mind  for  that  matter),  and 
how  easy  it  would  be  to  logically  follow  up  that  simple  state- 
ment of  fact  and  show  comprehensively  that  that  cave  or  dwell- 
ing varied  in  size  with  the  requirements  of  the  human  numer- 
ically, and  that  it  varied  in  kind  with  the  requirements  of  the 
human  geographically. 

Could  I  not  very  naturally  go  on  to  show  how,  with  the 
evolution  of  man  from  prehistoric  type  to  complexly  civilized 
variety,  desires,  requirements  and  habits  changed  and  brought 
on  housings  as  different  from  the  prehistoric  cave  in  appear- 
ance and  in  service  as,  let  us  say,  Gladstone  differed  in  type  and 
mentality  from  prehistoric  man? 

So  may  I  not  very  simply,  and  very  truthfully,  and  with 
clarifying  and  illuminating  sequence,  go  to  the  next  statement 
which  tells  us  that  with  the  great  increase  in  the  human  species, 
came  the  emigration  of  tribes  into  various  corners  of  the  globe, 
and  that  their  various  requirements  in  the  direction  of  being 
properly  housed,  were  influenced  as  before  by  geographic  and 
geologic  conditions !  Perhaps  too,  in  their  travels  to  their  new 
locality,  they  had  imbibed  some  of  the  beauty  of  Nature's  vast 
architecture,  and  had  become  desirous  of  injecting  part  of  it 
into  their  own  handiwork.  This  seems  very  reasonable,  and  so 
one  can  go  on  and  readily  proceed  to  show  how  the  architecture 
of  today  originated,  how  it  grew  and  developed  into  its  apparent 
complexity,  but  in  reality  into  its  scientific  simplicity.  I  can 
trace  them  all,  the  Greek,  the  Koman,  the  Ionic,  the  Benaissance, 
etc.,  and  can,  after  tracing  them  all  with  proper  sequence  and 
perfect  logic,  so  converge  my  findings  as  to  very  properly  feel 
that  the  very  best  thought  with  which  to  close  the  book  on  archi- 
tecture would  be  the  thought  that  the  human  is  poorer  than  the 
animal  in  brute  force,  but  richer  than  the  animal  in  intellect. 
So,  in  the  beginning,  for  his  own  preservation  and  protection, 


24  CAST  GOLD  AND  PORCELAIN  INLAYS 

and  for  the  protection  and  preservation  of  his  species,  he  built 
himself  a  cave,  and  it  grew  and  he  grew;  and,  because  of 
superior  intellect,  he  outgrew  the  cave  and  built  for  himself  a 
hut;  and  because  his  intelligence  further  grew,  he  discarded 
his  hut  and  built  for  himself  a  house — mark  you,  a  house.  Still 
his  intellect  grew  and  lie  traveled;  and  he  saw  the  wonderful 
beauty  of  the  heavens  and  the  earth,  and  the  sun,  and  the  stars, 
and  the  streams,  and  the  oceans,  and  lo  and  behold!  his  desires 
to  see  all  these  beauties  before  him  at  all  times  were  father  to 
his  attempt  to  reproduce  them  in  his  dwellings!  So  his  intellect 
grew,  and  so  art  was  born,  and  so  man  builds  for  himself  palace« 
and  paints  for  himself  pictures  of  the  things  he  has  seen  in  his 
migrations  and  travels. 

THE  CHIEF  FACTORS  INDUCING  COORDINATE 
MENTAL  EFFORTS 

The  Optic  Sense 

A  fact  has  been  poorly  stated,  or  a  statement  has  been 
improperly  presented,  unless  it  produces  within  the  mind  of 
the  person  to  whom  it  is  presented  a  coordinate  effort  reaching 
out  for  further  information  on  the  same  subject.  Thus  a  subject 
is  never  closed,  never  completed  until  its  power  to  awaken 
mind-developing  desires  and  efforts  for  further  research  in  it, 
has  been  exhausted. 

Mental  efforts  are  of  two  kinds — mind-developing  and  mind- 
disturbing.  Both  may  be  coordinate,  and  both  may  mean  mental 
activity.  One  is  productive  and  good;  one  is  destructive  an-d 
hurtful.  One,  being  good,  is,  of  course,  absolutely  harmless; 
one,  though  hurtful,  may,  for  a  long  period,  seem  productive 
and  good;  thus  its  malignancy  is  greater  than  it  first  appears 
to  be. 

The  things  we  see,  the  things  we  hear,  the  things  we  touch, 
the  things  we  read,  all  induce  mental  efforts  of  one  kind  or 
another.  These  mental  efforts  are  crystallized  into  thought, 
and,  as  the  case  may  be,  these  thoughts  manifest  themselves 
in  our  acts,  daily  or  unusual.  If  the  things  we  see  are  beautiful 
to  us,  the  pleasing  effect  upon  our  retinae  is  cumulative  and  re- 


XCE    OF    TIKHHJliT  25 

current;  and  directly  as  tlie  effect  upon  our  visual  sense  is  the 
power  of  the  things  we  see  to  induce  coordinate  mental  effort. 
To  see  a  thing  beautiful  is  to  long  to  see  more  of  it,  to  be  near 
it — that  is  the  first  mental  effort  induced  upon  us.  Although 
some  may  not  consider  it  so,  in  the  ultimate  analysis  we  learn, 
nevertheless,  that  it  is  so. 

\Ve  go  forth  on  a  hot  summer  day  to  find  the  cooling  com- 
fort of  some  wooded  country  section.  AVe  enter  the  confines 
of  this  section  and  our  visual  sense  is  pleased.  That  pleasure 
is  immediately  reflected  in  our  mental  self,  in  that  it  causes 
us  to  pause  for  a  fraction,  or  an  hour,  or  a  day,  and  demands 
that  we  look  again,  be  it  at  the  soft  green  of  the  grass,  or  the 
tall  trunks  of  the  trees,  or  the  overhanging  bowers  of  whis- 
pering leaves;  and  we  do  look  again,  and,  looking  again,  we  love 
the  scene  more  and  long  more  for  it. 

This  coordinate  mental  effort  is  now  crystallized  into 
thought,  the  greatest  abstract  force  in  the  universe,  and  thought 
now  manifests  itself  in  our  very  next  act.  AVe  cast  about  for 
a  means  that  will  enable  us  to  see  and  absorb  more  of  the  beauty 
at  hand  with  the  least  expenditure  of  physical  effort.  It  is  not 
essential  that  we  see  this  green  grass,  these  tall  trees,  or  leafy 
bowers.  \Ve  may  will  for  them  only,  and,  if  our  mental  effort 
in  that  direct  ion  be  acute  enough,  we  may  run  through  the 
same  cycle.  Thus  we  have  the  will  producing  a  mental  effort, 
crystallizing  into  thought,  manifesting  itself  in  a  distinct 
physical  act.  There  is  the  subconscious  mental,  the  conscious 
thought,  and  the  physical  manifestation. 

The  will  to  call  forth  the  mental  impression,  crystallizing 
into  thought  on,  and  of,  beautiful  things, — such  thoughts  later 
manifesting  themselves  in  our  respective  acts — while  calling 
for  both  mental  and  physical  activity,  is  in  no  way  hurtful  or 
exhaustive. 

AVe  leave  our  enchanted  little  Eden,  or  oasis,  and  come  out 
into  the  broad  grass  prairie  shriveling  beneath  brilliant  rays 
of  the  noon  sun.  AVe  are  as  yet  in  the  grasp  of  the  beautiful- 
aware  of  the  effect  produced  upon  us  by  our  communion  with 
the  beautiful  -and  the  sum  total  of  this  effect  is  in  the  period 
of  transition;  that  is,  in  the  process  of  being  stored  up  within 


26  CAST  GOLD  AND  PORCELAIN  INLAYS 

the  memory  cells  of  that  part  of  our  brain  which  concerns 
itself  with  the  doings  of  our  subconscious  ego.  We  see  nothing 
of  the  dying  grass  or  grain,  our  feet  move  lightly  over  the 
parched  earth,  while  our  eyes  are  turned  upward  in  awe  and 
wonder  and  admiration  of  that  wonderful  ball  of  shooting  fire 
sending  out  rays  that  light  and  heat  and  stimulate  to  growth 
a  billion  and  half  of  people,  and  a  quint illion  and  a  half  of 
animals.  As  we  look  upon  it  we  wonder,  and  will  to  look  upon 
it  more,  and  that  mental  effort  crystallizes  into  thought — coordi- 
nate, all  coordinate — and  yet,  what  is  this  physical  act  now 
manifesting  itself!  To  be  sure,  we  might  have  known,  the  rays 
of  the  sun  blind,  hurt,  and  cut  the  eye;  and  so  the  hand  goes 
up  to  shield  the  careless  member.  Now,  as  in  sheer  pain  we 
look  down  at  our  feet  and  visually  sweep  our  immediate  sur- 
roundings, we  see  that  the  rays  that  light  may  also  ignite,  the 
rays  that  heat  may  also  scorch,  and  the  rays  that  stimulate  may 
kill.  We  slowly  begin  to  realize  that  we  have  mistaken  a  mind- 
disturbing  mental  effort  for  a  mind-developing  one.  Both  are 
coordinate,  or  may  be;  both  mean  mental  activity.  One  is  pro- 
ductive and  good;  one  is  destructive  and  hurtful.  One  in  being 
good,  is,  of  course,  absolutely  harmless;  one,  though  hurtful, 
may,  for  a  long  period,  seem  productive  and  good.  Thus  the 
malignancy  of  some  mental  efforts  is  greater  than  it  first  ap- 
pears to  be,  as  shown  here  above. 

The  Auditory  Sense 

The  things  we  hear,  how  powe<rful  a  factor  are  they  in 
arousing  us  to  mental  efforts,  mind-developing  or  mind-disturb- 
ing, as  the  case  may  be !  Because  of  things  heard,  empires  were 
born  and  destroyed,  maps  of  continents  were  changed,  armies 
faced  one  another  in  gory  contests,  and  innumerable  lives  were 
sacrificed  upon  the  altar  of  gossip ! 

Krishna,  Confucius,  Buddha,  and  Moses  heard  the  voice  of 
the  great  Universal  Mind,  or  Spirit,  or  Soul,  and  the  fate  of 
millions  was  changed.  Pharaoh  heard  the  voice  of  Moses,  and 
the  children  of  Israel  were  free  to  follow  the  great  leader.  Yes, 
and  the  children  of  Israel  heard  the  voice  of  discontent  and 
greed,  and  they  were  ready  to  follow  the  golden  calf.  Cleopatra 


SEQUENCE    OF    T  If  OUGHT  27 


heard  of  the  great  Antony,  and  the  conquest  of  Egypt  way 
the  time  being  forgotten.     Octavius  then  heard  the  voice  of 
opportunity,  conquered  Egypt,  and  Cleopatra  died. 

Like  other  great  leaders  mentioned,  Jesus*  heard  the  voice 
and  transmitted  and  translated  it  to,  and  for,  the  people,  in  the 
si  i  ape  of  a  doctrine  of  righteousness  and  goodness  and  peace  and 
tranquillity  and  happiness.  The  people  were  free  to  follow  if 
they  willed,  and  some  did;  but  the  great  number  heard  the 
voice  of  doubt,  and  they  are  still  traveling  in  the  desert. 

The  voice  Jesus  heard  and  gave  to  the  people  —  what  has 
become  of  it,  and  what  have  they  done  with  his  teachings? 
There  are  a  dozen  different  sorts  of  Christians,  each  proclaim- 
ing themselves  the  right  sort  and  real  original  followers  of 
Him  who  heard  the  voice  and  told  freely  of  what  He  heard, 
and  none  of  the  different  ones  professing  belief,  have  faith 
enough  to  realize  that  they  themselves  may  hear  the  great  Voice 
if  they  but  will  to  hear  it.  But  they  have  heard,  instead,  the 
voice  of  doubt,  and  the  mirage  upon  the  sands  of  their  own 
mental  desert  lures  them  astray. 

And  we,  who  some  time  or  other  go  forth  upon  some  pleas- 
urable little  excursion  and  perhaps  lose  our  way  for  a  spell  in 
the  tranquillity  and  peace  of  the  forest,  may  just  be  fortunate 
enough  to  come  upon  some  bird  singing  his  love  song  to  the 
creative  spirit.  As  we  hear  the  wonderful  notes  tumbling  over 
one  another  in  their  eagerness  to  arrange  themselves  into  a  per- 
fect ly  wonderful  symphonic  harmony  of  appreciation  and  joy, 
we  are  enthralled  and  roused  at  once.  That  is  the  impression, 
is  it  not?  Now  comes  our  mental  effort  to  follow  each  trill 
and  each  bend  of  each  note;  and  that  mental  effort  —  is  it  not 
crystallized  into  thought  —  that  great  abstract  force  in  the  uni- 
verse  —  as  wTe  begin  to  think  of  the  wonder  of  it  all  and  marvel 
at  the  beauty  and  its  influence  upon  us?  And  does  not  this 
thought  now  manifest  itself  in  our  very  next  physical  act,  in 
that  our  very  physical  being  smiles  for  sheer  joy,  our  head  is 
erect,  our  ears  are  alert,  our  chest  is  expanded,  and  we  are, 
in  fact,  physically  better  for  having  heard  the  voice  that  induced 
the  will  to  cause  the  mental  effort  which  crystallized  into 

*The  nanio  Jesus  is  IK-IT  usi-d  to  epitomize  the  ideal  monotheistic  man,  the 
iilrul  Israelite,  who  so  thoroughly  recognized  his  relationship  to  the  Cosmos  and 
whose  work  has  been  "  most  ignored  by  those  who  most  pretend  to  follow  him. 


28  CAST  GOLD  AND  PORCELAIN  INLAYS 

thought,  and  which  thought,  almost  instantaneously,  manifested 
itself  in  a  distant  physical  act?  And  again  let  it  be  said  that 
the  will  to  call  forth  the  mental  effort,  crystallizing  into  thought 
on,  and  of,  beautiful  things,  and  which  thought  later  manifests 
itself  in  a  distinct  physical  act,  while  calling  for  both  mental 
and  physical  activity,  is  in  no  way  hurtful  or  exhausting. 

As  we  leave  the  foliage  home  of  the  Great  Spirit,  the  home 
where  every  tree,  every  branch,  every  leaf,  is  an  altar  of  wor- 
ship and  a  worshiper  at  once,  and  where  every  bird  worships 
his  Creator  in  musical  praise  and  adoration,  we  are  as  yet  in 
the  grasp  of  symphonic  harmony,  aware  of  the  effect  produced 
upon  us  by  our  communion  with  the  beautiful,  and  the  sum 
total  of  this  effect  is  in  its  period  of  transition,  so  far  as  we 
are  concerned;  that  is,  it  is  in  the  process  of  being  stored  up 
within  the  memory  cells  of  that  part  of  our  brain  which  concerns 
itself  with  the  doings  of  our  subconscious  ego. 

We  are  out  of  the  foliage,  into  the  field,  with  a  clear  view 
for  rods  ahead  of  us,  and  we  see  in  the  distance  swarming 
masses  of  people;  we  realize  suddenly  that  some  sound  is  crav- 
ing our  aural  attention.  It  is  music  too.  The  will  to  determine 
the  change  as  to  kind  causes  a  mental  effort  to  compare.  X<>, 
it  is  not  the  immaculate  trill  of  the  song  bird, — not  the  per- 
fect, the  beautiful,  the  soulful  harmony  of  the  feathered  little 
interpreter  of  the  divine  language  of  perfect  trust  and  under- 
standing. It  is  the  intensely  electrifying  call  of  a  bugle  that  we 
hear, — that  is  the  thought  crystallized  from  the  mental  effort 
to  compare.,  which  in  turn  was  caused  by  our  will  to  determine 
the  change  as  to  kind;  and  that  crystallized  thought  now  mani- 
fests itself  in  a  distinct  physical  act,  in  that  we  hasten  our  walk 
to  more  quickly  reach  the  field  of  action.  Rapidly  we  walk 
onward,  our  eyes  fixed  upon  the  swarming,  teeming  mass,  our 
sense  of  hearing  alert  to  every  incisive  call  of  the  bugle,  inter- 
rupted and  augmented  now  and  then  by  the  thunderous  beating 
of  the  drum. 

Instinctively  we  realize  that,  as  a  part  of  the  teeming, 
swarming  mass  of  men,  we  are  facing  some  sort  of  a  crisis. 
\Ve  are  near  enough  now  to  recognize  that  two  opposing  armies 
are  engaged  in  a  hand  to  hand  battle;  we  hear  the  clang  of  the 


SEQUENCE    OF    THOUGHT  29 

bayonet  and  the  rays  of  the  sun  scorn  to  dissolve  the  blades 
into  an  ever  halving-  ocean  of  scintillating  steel.  Upon  a  hill 
not  far  distant,  the  artillery  is  feverishly  working  to  get  the 
rapid-firing  gun  into  action;  and  now  the  prophet  of  death  and 
destruction  and  desolation  speaks  in  a  staccato  of  killing  syl- 
lables. And  man,  the  image  of  Ciod,  kills;  and  man,  the  image 
of  God,  dies, — a  roar  of  victory,  mingled  with  a  cry  of  pain! 

The  bugle  calls,  the  drum  encourages,  the  army  rushes 
forward,  the  conquered  slowly  retreat.  Another  roar  of  the 
cannon,  another  Catling  gun  address  from  the  hilltop,  and  more 
things  made  in  the  image  of  God  see  no  more,  hear  no  more,  and 
work  no  more.  The  conquered  host  becomes  disorganized  and 
breaks  into  a  demoralized  run,  leaving  the  field  of  conquest 
strewn  with  the  bleeding  dead. 

Tremblingly  we  hear  the  bugle  call  again,  a  long  call,  a  sort 
of  minor  note,  plaintive  and  gladsome  at  once,  followed  by  an 
insistent  and  imperative  order  to  desist  from  pursuit  and  cease 
firing. 

The  battle  is  over.  We  realize  somewhat  hazily  as  yet,  that 
somehow  humanity  has  been  weighed  and  found  wanting,  that 
it  has  been  tricked  by  its  own  lack  of  understanding.  We  can 
see  the  suffering  thousands  writhing  in  the  death  agony  of 
man-inflicted  wounds.  We  can  picture  to  ourselves  the  thou- 
sands of  homes  of  mourning,  of  despair,  of  desolation.  We  see 
widowed  women,  orphaned  children,  starving  families,  uttering 
prayer  upon  prayer,  and  curse  upon  curse.  We  can  see  also  the 
land  of  the  victorious  in  the  throes  of  delirium.  The  news- 
papers are  singing  the  praise  of  the  great  victorious  soldiers. 
The  town  is  decorated  in  their  honor.  We  see  the  fireside  of 
the  returned  victor  ablaze  with  light;  joy  seems  to  have  run 
riot  in  this  circle;  a  helpmate  and  clinging  children,  eagerly 
listening  to  his  minute  account  of  the  great  battle ;  he  glories  in 
the  mess  of  blood  and  carnage  left  behind  him;  his  face  seems 
transfixed;  his  eyes  are  staring  straight  ahead.  His  finger 
pointing  at  the  imaginary  foe,  he  tells  what  a  wonderful,  mad- 
dening effect  the  persistent  call  of  the  bugle  had  upon  his  men- 
how  it  spurred  them  on  to  victory,  and  the  enemy  on  to  death. 

The  reaction  is  upon  us  in  its  full  and  remorseless  effect. 


30  CAST  GOLD  AND  PORCELAIN  INLAYS 

Dry  sobs  of  contrition  may  shake  our  physical  frame,  but  they 
are  as  nothing  to  the  mental  agony  we  have  gone  through. 
Weary  in  body  and  mind,  we  ponder  over  the  whole  problem, 
and  slowly  the  mist  begins  to  clear.  AYith  the  clearing  of  the 
mist,  comes  power  of  greater  mental  vision,  and  we  begin  to 
analyze  the  situation;  to  reach  into  the  vitals  of  the  wherefore; 
to  find  that  humanity  has  been,  and  is  still,  being  tricked  into 
murderous  impulses  and  killing  contests — not  by  the  call  of 
the  bugle,  not  by  the  beating  of  drums,  but  by  a  lack  of  clear 
understanding,  a  lack  of  a  clear  vision,  an  incapability  of  seeing 
the  great  love  light  of  the  infinite  tolerance,  and  absence  of 
unity  of  purpose,  and  a  greedy  desire  for  advantage. 

False  leaders,  pointing  the  road  into  eternal  darkness,  con- 
taminate unto  vileness  the  minds  of  their  weakened  followers 
with  doctrines  that  are  as  ephemeral  as  their  motives  are  greedy. 
They  are  responsible  for  the  mental  misconception  of  real  issues 
by  a  heretofore  real  people. 

A  year  passes  by,  and  the  doctrines  fall  to  pieces — collapse 
because  they  were  built  upon  the  quicksands  of  untruth.  Other 
false  leaders  with  other  false  doctrines  play  their  enticing  tunes 
to  win  the  crowds;  and  so  things  have  been  going  on  until 
man's  mind  (mass  man,  I  mean)  has  become  a  chaos,  a  wilder- 
ness, an  instrument  readily  responding  to  martial  influence  and 
impulses — ready  ever  to  be  in  on  a  killing. 

The  teachers,  the  leaders,  their  teachings,  and  their  doc- 
trines, are  to  blame.  The  warping  of  the  public  mind  is  their 
doing,  since  they  have  had  the  public  ear;  the  public  eye  has 
been  upon  them.  The  misapplication  of  the  public's  mental 
power  to  malformed  problems  presented  and  ever  represented 
with  the  sole  purpose  of  so  bewildering  the  public  mind  that 
the  real  issue  will  forever  be  clouded  and  not  be  seen  by  it,  may 
be  laid  directly  at  the  door  of  those  whose  teachings  have  been 
accepted,  and  are  being  followed  by  the  public. 

They  have  men  in  such  a  condition  mentally  that  they  will 
stand  up,  face,  and  kill  one  another  for  so-called  good  reasons, 
ever  kept  before  them  by  industrious  exponents  of  the  teach- 
ings; and  should  they  threaten  to  lag  or  demur  or  should  per- 
chance a  ray  of  reason  or  light  enter  the  mind  of  the  killer  or 


SEQUENCE    OF    THOUGHT  31 

victim,  and  lie  begin  to  doubt  the  wisdom  of  killing  or  being 
killed,  the  heroic  bugler  is  pressed  into  service  with  his  elec- 
trifying clarion  call,  and  the  thunderous  drum;  and  dare-devil- 
ishly, he  puts  his  entire  lung  power  into  his  efforts  to  rally  and 
encourage  his  comrades  to  face  a  few  bullets  and  perpetuate  the 
system,  always  the  same — the  doctrines  apparently  ever  chang- 
ing with  the  leaders,  but  the  system  always  the  same.  Onward 
Christian  Soldiers! 

And  so  they  rally.  They  hear  the  call  of  the  bugle,  and  the 
healing  of  the  drum,  and  that,  to  them,  means  kill,  and  they 
kill.  That  the  bugle  call  is  music  does  not  matter;  that  music 
is  the  immaculate  language  in  which  all  bird  life  speaks  to  its 
creative  spirit  does  not  matter  to  the  system;  that  music  is  the 
infinite  language  that  makes  possible  the  intercommunication 
of  spirits,  even  as  ordinary  words  make  possible  the  intercom- 
munication of  man,  does  not  matter. 

The  soldier,  the  citizen,  the  people,  they  'have  been  told 
and  they  know;  they  know,  that  bugle  calling  means  rally— 
that  bugle  calling  means  kill;  and  so  to  them  the  waves  of 
electrifying  sound  have  a  destructive  undertow,  the  bewitching 
tune  of  the  bugle  is  the  reaper's  own,  and  the  symphony  that 
urges  them  on  to  battle,  leads  them  unto  death. 

\Yc  slowly  begin  to  realize  that  they  have  mistaken  a  mind- 
disturbing  mental  effort  for  a  mind-developing  one.  Both  are 
coordinate,  or  may  be;  both  mean  mental  activity.  One  is 
productive  and  good,  one  is  destructive  and  hurtful.  One,  be- 
ing good,  is,  of  course,  absolutely  harmless;  one,  though  hurtful, 
may,  for  a  long  period,  seem  productive  and  good.  Thus  the 
malignancy  of  some  mental  efforts  is  greater  than  it  first  appears 
to  be,  as  shown  here  above. 

The  Tactile  Sense 

We  have  reached  so  nearly  the  vulnerable  vitals  of  our 
present  civilization,  that  it  will  prove  a  relief  to  retreat  into  the 
past. 

If  we  attempt  to  learn  how  much  of  an  influence  the  things 
we  touch  may  have  in  arousing  us  to  mental  efforts,  mind-devel- 
oping or  mind-disturbing,  as  the  case  may  be,  it  obviously  'can 


32  CAST    GOLD    AND    POIU'KI.AIX     INLAYS 

make  little  difference  whether  we  arc  passive  or  active  in  our 
process.  In  other  words,  for  the  purpose  of  consideration,  it 
will  serve  equally  well  to  consider  the  sense  of  touch  as  a  factor 
in  repose,  actod  upon;  or  in  active,  investigating-  exercise  of  its 
function. 

Touch  is  first,  accidental,  impulsive,  or  premeditated;  then 
it  is  either  seriously  or  idly  investigative,  defensive  or  offensive, 
prehensile  or  repelling,  cruel  or  caressing,  constructive  or  de- 
structive. It  is  therefore,  respectively  pleasing  or  abhorrent, 
and  in  its  final  effect  either  salubrious  or  hurtful. 

Touch,  in  itself  is  a  distinct  physical  act,  either  accidental, 
impulsive,  or  premeditated;  and,  being  a  distinct  physical  act, 
it  has  behind  it  the  abstract  force  called  thought,  crystallized 
from  some  previous  mental  effort.  Our  investigation  of  its  in- 
fluence in  rousing  us  to  mental  efforts  must,  therefore,  be  less 
circumscribed,  but  more  fully  rounded.  To  put  it  into  very 
simple  language,  it  is  a  case  of  starting  at  a  beginning,  com- 
pleting a  cycle,  and  coming  back  to  a  start. 

When  touch  is  accidental,  the  mental  effort  it  rouses  crys- 
tallizes into  a  thought  which  manifests  itself  into  a  distinct 
physical  act,  which  is  usually  involuntary,  automatic,  and  bene- 
ficial. 

When  touch  is  premeditated,  it  is,  as  said  before,  the  mani- 
festation of  a  thought,  or  thoughts,  crystallized  from  a  previous 
mental  effort,  and  any  mental  efforts  aroused  by  the  physical 
act  of  touching  will  be  secondary,  coordinate,  and  deductive, 
which  secondary,  coordinate  and  deductive  efforts  will  again 
crystallize  into  coherent  thought,  which  thought  will  manifest 
itself  in  a  physical  act.  This  will  go  on  in  rotation,  until  the 
power  of  the  thing  we  touch  to  awaken  within  us  mind-develop- 
ing desires  and  efforts  to  further  research  in  it  shall  have  been 
exhausted,  for  the  time  being  at  least. 

It  will  not  do  to  continue  this  any  further  at  preseait,  for 
the  simple  reason  that  while  every  statement  made  is  absolutely 
true,  it  does  not  necessarily  follow  that  the  mere  statement  of  a 
truth  makes  it  acceptable  dogma  to.  the  reader  or  student. 

Since  truth  is  conclusive,  it  follows  that  the  student  has  a 
right  to  read  and  review  that  which  led  me  to  truth  and  con- 


SKO.UKXCK    OK    TIIOCGHT  33 

elusion,  so  that  lie,  the  student,  be  enabled  to  reason  as  lie  reads, 
and  perhaps  reach  the  same  conclusion  as  I,  and  that  before 
having  read  mine-. 

And  so  let  us  all  go  back  to  the  past — not  too  far  back  at 
once,  lest  we  lose  our  way  in  the  labyrinth  of  eternal  time; 
but  let  us  go  back  to  the  day  when  Hying1  machines  were  not 
a  reality.  That  is  not  so  Jong  ago.  Here  let  us  stop  for  a 
moment,  to  find  that  we  were  quite  the  same  people,  with  quite 
the  same  habits,  opinions,  and  peculiarities  even,  as  we  are 
now. 

For  the  purpose  of  our  present  needs,  we,  therefore,  find 
flying-machinelees  time  barren  of  attraction,  and  touch  upon 
it  only  to  mark  a  milepost  on  the  road  upon  which  we  journey. 
Back  farther  we  must  go  to  the  next  previous  era  in  the  com- 
plex commercial  growth  of  our  means  of  get-aboutness;  and 
so  we  linger  at  the  point  when  railroads  were  not  in  existence, 
and  scan  this  period  for  any  ray  of  light  it  may  throw  upon  our 
subject. 

But,  first,  we  shall  mark  the  place  with  another  milepost. 
\Ye  have  wriggled  through  the  underbrush  of  centuries  of  time, 
with  their  obliterating  effect  of  forgetfulness,  and  we  must  be 
careful  to  blaze  the  trail  so  that  we  may  safely  return  to  the 
present.  \Ve  shall  find  ourselves  in  strange  surroundings  upon 
our  return,  else  our  journey  into  the  past  shall  have  been  in 
vain. 

A  railroad  is  a  carrier  born  of  the  human  desire  to  con- 
serve time. 

Time,  next  to  thought,  is  the  most  precious  heritage  of 
man.  Time  is  life,  real  eternal  life.  A  waste  of  time  is  a  waste 
of  life.  Anything  which  conserves  time  conserves  life. 

A  railroad,  as  a  carrier,  shortens  the  time  it  takes  to  reach 
one's  destination  from  a  given  starting  point.  One  can  reach 
two,  three,  or  four  places  in  the  time  it  took  to  reach  one.  The 
railroad  made  four  hours  grow  where  but  one  grew  before. 
To  put  it  differently,  four  lives  are  mine  who  lived  but  one 
before. 

A  railroad  is  great  because  it  serves;  and  its  greatness 
is  in  proportion  to  the  multitude  it  serves.  More  service — more 
greatness. 


34  CAST    GOLD    AXO    POltCKLAIX    INLAYS 

On  the  principle  that  no  part  can  he  greater  than  the  whole, 
the  railroad  can  not  be  greater  than  he  who  conceived  it;  and 
yet  lie  who  conceived  it  may  find  that  it  outgrew  his  conception. 

A  railroad  is  definite,  dependable,  and  helpful  because  it 
has  a  plan,  a  starting  point,  and  a  destination.  Nothing  else 
but  good  management  matters.  Given  the  four  mentioned  units 
working  in  unison,  a  railroad  serves,  and,  serving,  becomes 
great. 

We  lived  before  the  raliroads  Avere  built;  we  lived  quite 
as  long,  but  more  meagerly,  more  slowly,  and  intellectually, 
more  poorly.  AVe  could,  in  our  lifetime,  see  but  one  small  part 
of  the  things  we  may  see  today,  and  so  we  could,  in  our  life- 
time, learn  to  know  but  part  of  what  we  may  learn  to  know 
today.  Possession  of  knowledge  means  possession  of  power- 
as  the  former  grows,  the  latter  multiplies. 

AVe  were  then  a  people,  slower  of  motion,  more  meager  of 
life,  and  poorer  in  knowledge;  but  we  were  great;  for  we  con- 
ceived the  thing  we  needed  to  ma"ke  us  quicker  of  motion,  less 
meager  of  life,  and  more  wealthy  of  knowledge. 

Ours  is  the  railroad  by  right  of  conception,  inception,  and 
safe  birth.  AVith  all  its  wonderful  attributes  and  cumulative 
powers  for  good,  the  railroad  outgrew  our  conception  of  it.  AVe 
conceived  it  for  service  and  serving;  it  became  great,  and  having 
become  great,  we  serve  it. 

Like  great  arteries  supposed  to  carry  life-giving  substance 
to  the  remotest  parts  of  the  great  body  of  the  people,  railroads 
now  wind  their  course  through  the  various  sections  of  the  con- 
tinent, but  we,  who  conceived  them,  own  them  no  more;  they 
have  slipped  the  halter  of  the  multitude  and  become  the  weapons 
of  the  few  who  are  ever  present  in  all  communities. 

The  better  the  railroads,  the  more  dangerous  a  weapon  in 
the  hands  of  the  few,  and  the  greater  menace  to  the  many. 

So  it  would  seem  that  good  roads  are  bad  when  they  are 
very  good,  and  bad  roads  are  not  good  even  because  they  are 
bad. 

But  it  seems  that  the  multitude  might  learn  from  the  rail- 
roads, and  have  a  plan,  a  starting  point  and  a  destination- 
manage  its  affairs  well.  Given  these  units  working  in  unison, 


SKQTKNCK    OF    TIlorcilT  35 

a  multitude-  shall  serve  itself  best,  and,  serving,  it  shall  become 
great. 

It  must  be  remarked  in  passing  that  we  are  an  impatient 
race,  all  apparent  evidence  to  the  contrary.  \Ve  may  be  la/y 
or  indolent  and  our  point  of  view  perv<  rted,  but  we  really  are 
impatient,  which,  if  we  acknowledge  it,  proves  that  we  are  ever- 
changing. 

The  thing  to  do  seems  too  obvious  to  require  notice.  If 
our  point  of  vie^w  is  perverted,  and  we  are  impatient  and  are 
ever-changing,  then  in  order  to  turn  all  our  seeming  detriments 
into  benefits,  we  need  but  change  our  point  of  view;  for  that 
becoming  correct,  and  we  being  impatient,  and  we  ever-chang- 
ing we  should  then  change  in  the  direction  of  greater  growth 
and  consequently  progress. 

Our  view  was  not  always  perverted,  for  taking  our  im- 
patience for  granted,  we  have  progressed  in  a  way,  or  we  never 
could  have  conceived  the  railroads.  The  heavens  are  not  al- 
ways immaculate,  and  the  earth  is  not  always  wicked,  but  one 
would  not  dream  of  asserting  that  heaven  was  heaven  because 
it  is  not  always  immaculate,  and  that  the  earth  persists  because 
of  its  wicked  intervals. 

(iood  never  comes  from  evil,  but  makes  itself  felt  in  spite 
of  it;  and  so  our  progress  has  come,  not  because  our  point  of 
view  was  perverted,  not  because  we  were  lazy  or  indolent,  etc., 
but  in  spite  of  these  things. 

Our  restlessness,  our  impatience,  in  their  spasmodic  efforts 
to  rouse-  us,  overcame  our  indolence.  Our  needs,  manifesting 
themselves,  ihe  spark  of  intelligence  was  fanned  into  the  flame 
of  invention.  The  results  were  progressively  and  cumulatively 
good,  until  our  definite  intention  to  grow  was  blurred  by  our 
worship  of  the  evidence  of  our  growth,  and  we  ceased  growing 
to  serve  growth. 

AVhat  has  been  said  of  the  railroads  applies  to  the  steam- 
ships, and  in  sequence  to  the  horse,  and  the  sailing  vessel,  and 
again  in  sequence  to  the  ox-team  and  the  rowboat,  and  in  se- 
quence again  to  man's  travel  on  foot  and  to  the  log  which  served 
him  in  crossing  the  first  body  of  water,  which  interposed  itself 
between  him  and  further  lands. 


36  <AST    GOLD   AND    PORCELAIN    1XLAYS 

A  huge  reel  of  film,  rich  in  telling  and  epoch-making  events, 
unrolls  itself  before  our  mental  eye,  and  we  see  the  civilization 
of  today,  and  of  yesterday,  of  this  year  and  yesteryear,  and  of 
this  century  and  the  last;  and  through  it  all,  perhaps,  the  same 
figure  of  man,  the  same  grace  of  woman.  We  see  the  almost 
ideal  Switzerland,  the  would-be-right  New  Zealand,  England 
and  its  Monarchy,  France  and  its  Republic.  Russia  rises  and 
growls  at  us  and  reveals  one  of  the  bloodstains  of  the  last 
centuries.  Turkey  staggers  under  her  misdeeds,  and  we  call 
Germany  efficient.  More  films  are  seen  as  we  go  deeper  into  the 
past.  We  see  Austria  born  and  Spain  at  its  height,  while  the 
boot  of  Europe  attempts  to  crush  the  Hebrew  race  and  loses 
prestige  for  its  pains.  Darkness  alternates  with  light,  the  stars 
are  cloud-obscured,  and  still  perhaps  the  same  figure  of  man, 
the  same  grace  of  woman.  More  films.  The  Roman  empire  in 
its  powerful  strides  towards  the  rule  of  the  earth;  Greece,  the 
beautiful  mother  of  the  beautiful.  The  Huns  terrorize  a  con- 
tinent, and  the  scene  shifts  to  Asia,  to  Africa,  to  America — 
no  matter.  Now  see  the  Ancients  come  to  life;  the  building  of 
the  house  of  worship  of  one  and  only  one  God  by  the  Jews;  the 
rise  of  the  same  race  from  slavery  to  the  position  of  powerful 
people.  See  the  mummies  of  ancient  Egypt,  and  follow  the  lore 
of  the  Chaldeans.  See  Assyria,  Babylonia,  Arabia,  and  now  see 
Egypt  at  its  height  of  glory  about  to  be  humbled. 

Watch  the  films  and  see  the  dismemberment  of  nations,  the 
dwindling  of  powers,  and  the  loss  of  definition  as  to  the  out- 
line, boundary,  and  position  of  authority.  Eons  are  passing  and 
you  must  note  the  gradual  and  persistent  change  in  the  human 
being,  as  we  recede  into  the  hazy  past. 

When  we  reach  the  beginning  of  the  cave  era  in  the  de- 
velopment of  man,  we  shall  have  gone  back  far  enough  for  our 
present  needs;  for  the  difference  in  the  man  of  today  and  the 
man  of  erstwhile  cave  time,  is  so  unquestionably  apparent  that 
no  one  will  fail  to  see  it. 

It  will  be  noted  that  we  have  retraced  our  march  to  the 
beginning  of  the  cave  era,  and  our  reason  for  this  was  to  get 
in  touch  with  the  human  while  he  was  in  a  transition  period, 
about  to  climb  from  a  lower  to  a  higher  level ;  our  purpose  be- 


SEQUENCE    OF    THOUGHT  37 

ing  to  ascertain  .just  what  part  the  sense  of  touch,  active  or 
passive,  played  in  the  transition  of  the  animal  biped,  from  a 
beast,  lacking  in  intelligence,  to  a  comparatively  intelligence- 
possessed,  nearly  human  being. 

It  must  be  remembered  that  these  beings  were  the  fore- 
runners of  man  of  today,  they  lived  in  the  day  and  through 
it  without  a  thought  of  the  morrow.  Might  alone  was  the  tri- 
bunal that  decided  for  them.  Their  members  were  few,  and 
they  had  reached  their  present  stage  in  their  evolutions  from 
the  primordial  slime,  through  no  conscious  cooperation  on  their 
part.  Like  animals,  they  possessed  the  instincts  of  the  sexual 
urge,  and  the  females  had  perhaps  in  addition  to  that  the  in- 
stinct of  mother  love. 

Suppose  we  select  for  the  purpose  of  close  observation, 
three  characters  from  this  unhurried  mass,  and  that  these  are 
Brute  Force,  "Weak  Hands,  and  Lily-white. 

Brute  Force,  huge,  massive,  coarse-featured,  sleepy,  glut- 
ton-faced, hairy,  small-eyed,  low-browed,  a  voice  like  a  lion's 
roar,  a  rage  like  the  rending  asunder  of  mountains,  slow  of 
motion,  and  indifferent  to  surroundings,  a  consciousness  of 
power,  only  because  bigger  in  bulk  than  the  rest. 

Weak  Hands,  tall,  comparatively  lean,  agile,  restless  of  "eye 
and  limb,  rebellious  in  movement,  alert  ever  to  the  impending 
danger  of  crossing  the  path  of  the  Brute,  and  resentful  in  every 
motion  of  his  quick  body. 

Lily-white,  the  female  of  the  species,  lithe  in  form,  well- 
shaped  in  limb,  clear-eyed,  well-featured  and  long-haired,  sin- 
uous of  motion,  sensuous  in  the  pursing  of  her  lips.  She  looked 
well  to  the  right  of  her  and  well  to  the  left  of  her,  behind  and 
in  front  of  her.  She  saw  Brute  Force  and  the  likes  of  him, 
and  liked  them  not.  He,  she  figured  in  her  simple  intuition, 
would  crush  her  with  his  ponderous  bulk.  She  could  feel  his 
hot  stinking  breath  upon  her,  and  she  reeled  with  apprehension 
and  illness. 

To  him  she  would  mean  nothing — could  mean  nothing — but 
a  mass  to  be  ripped,  torn,  rent  asunder  into  shapeless  chaos  to 
satisfy  his  brutish  sexual  vehemence. 

She  stroked  her  arms,  her  face,  her  breasts  covered  with 


38  CAST    GOLD    AND    rOltl'KLAlN     INLAYS 

her  long  lustrous  hair,  she  allowed  her  hands  to  gently  caress 
her  belly,  and  she  trembled  violently  as  she  contemplated  her 
helplessness. 

And  yet,  there  was  \Veak  Hands,  she  rather  favored  him; 
they  seemed  companions  in  their  fear  of  Brute  Force.  She  could 
contemplate  cave  relations  with  Weak  Hands  without  consider- 
ing herself  a  shapeless  mass  in  the  aftermath.  She  could  even 
crave  cave  relations  with  Weak  Hands,  for  her  instinct  told  her 
it  was  good. 

Weak  Hands  was  to  be  considered.  A  leer  came  into  Lily- 
white's  eye.  Weak  Hands  was  to  be  desired.  She  wanted  him. 
She  would  have  Weak  Hands  and  mate  with  him,  in  spite  of 
Brute  Force  and  his  like,  and  just  then  wary  Weak  Hands 
crawled  out  into  the  open  from  behind  a  rock  and  touched  Lily- 
white  gently.  She  wheeled  as  if  struck  and  they  faced  one 
another  for  a  spell.  On  his  pale  face  she  read  longing  and  crav- 
ing and  passion.  She  saw  his  muscles  twitch  like  the  twigs  of 
a  young  tree  in  a  fast  wind;  his  mouth  was  open  and  his  lips 
seemed  dry;  his  tongue  seemed  to  fairly  force  his  breath  out  of 
him.  His  eyes  were  fixed  upon  her  and  seemed  to  travel  from 
her  face  down  to  her  well-muscled  abdomen  and  thighs.  Her 
hands  instinctively  shot  out  toward  him,  as  her  legs  began  to 
tremble.  Thus  Lily-white  conveyed  to  Weak  Hands  the  mes- 
sage that  she  was  ready  to  mate  and  she  wanted  to  mate  with 
him. 

They  were  forced  to  seek  cover  by  the  approach  of  Brute 
Force,  who  was  on  a  hunt  for  Lily-white.  She  ran  swiftly  in 
one  direction,  while  Weak  Hands  crawled  behind  the  rock  and 
thence  downward  until  he  reached  his  cave,  into  which  he 
wriggled.  Here  he  felt  safe  from  Brute  Force  and  his  roar. 
The  entrance  was  just  barely  large  enough  to  admit  the  occu- 
pant, but  far  too  small  for  the  great  hulk  of  the  giant  chief. 

Weak  Hands  sat  upon  a  stone  and  stared  into  the  semi- 
ilarkncss  of  his  cave.  He  reached  out  with  his  right  hand  and 
picked  up  a  stout  stick  that  lay  there,  to  carelessly  toy  with  it. 
His  hand  holding  the  stick  moved  aimlessly  across  the  floor  of 
his  cave  immediately  in  front  of  him,  and  in  its  wanderings, 
the  stick  embedded  itself  in  a  jagged  hole  of  a  round  piece  of 


OF  Tiiorcirr  39 

stone.  Weak  ] lands  tilled  at  tlie  stick  to  free  it  from  its 
prison,  but  in  vain.  His  inability  to  separate  the  two  tilings 
irritated  him.  The  small  piece  of  stone  was  held  in  place  by 
a  larger  piece  of  the  same  material,  and  the  stick  was  held  in 
the  jailed  hole  of  the  smaller  stone.  The  constant  tugging  of 
Weak  Hands  finally  moved  tlie  larger  stone  and  suddenly  the 
queer  combination  of  stick  and  stone  held  in  the  right  hand  of 
Weak  Hands,  as  liberated,  and,  describing  an  arc,  the  stone 
struck  the  cave  dweller  full  on  the  temple,  while  he,  losing  his 
balance,  found  himself  on  the  ground,  speculating  as  to  the 
peculiar,  strange,  and  unfriendly  behavior  of  his  slick  and  stone. 

A  change  came  over  the  cave  man.  He  raised  himself  care- 
fully and  very  slowly  into  a  sitting  position,  and  he  looked  first 
at  the  stick,  then  at  the  stone  on  the  end  of  it;  then  he  deliber- 
ately felt  his  head  where  it  had  come  in  contact  with  the  stone, 
and  then  he  again  looked  at  the  stone  and  the  stick,  brought 
them  nearer  the  entrance  and  the  light,  in  order  to  discover 
the  source  of  its  power.  With  that  end  in  view  he  swung  it 
slowly  and  gingerly  toward  his  head.  In  spite  of  his  care  the 
force  of  the  contact  startled  him  and  he  tried  again,  this  time 
on  his  thigh.  The  result  was  a  grunt  of  pain  and  satisfaction— 
if  we  can  conceive  any  such  combination. 

We  may  recognize  now  that  there  was  no  aimless  move  to 
be  detected  in  the  activity  of  Weak  Hands.  He  was  alive,  and 
intelligence  was  dawning;  that  means  that  his  movements  had 
behind  them  the  quality  of  volition.  The  accidental  and  then 
the  premeditated  touch  or  blow  he  had  given  himself  started 
things  going  in  his  mind.  The  touch  roused  a  mental  effort 
which  crystallized  into  thought,  and  these  thoughts  were  mani- 
festing themselves  in  his  immediately  following  physical  acts, 
as  we  shall  see  directly. 

Weak  Hands  crawled  out  of  his  cave  into  the  great  open 
and  stood  erect.  In  his  right  hand  he  carried  the  wonderful 
stick  and  stone;  he  brought  it  up  directly  in  front  of  him  and 
studied  it  in  awe  for  a  spell.  Suddenly  he  grasped  the  stick 
firmly  at  the  extreme  end  and  swung  it  with  all  the  force  that 
was  in  him  to  send  the  stony  end  of  it  swishing  into  the  earthy 
side  of  his  cave,  burying  the  stone  from  sight.  Weak  Hands 


40  CAST    GOLD   AXD   PORCELA1X    1XLAYS 

was  tensely  alert  now.  He  withdrew  his  find  and  looked  at  it 
again.  It  was  none  the  worse  for  its  work.  He  handled  it 
carefully  now — we  might  say  he  fondled  it;  he  stroked  the  stick 
and  stone  with  his  left  hand,  he  brushed  the  side  of  his  face 
against  it,  and  caressed  it  with  his  eyes.  This  satisfied  him  for 
a  few  brief  moments,  then  the  cave  man  became  strangely 
active.  He  found  an  enormous  stone  near  his  cave;  this  he 
moved  up  and  barred  the  entrance.  Then  he  turned  his  back 
upon  it,  his  extended  right  hand  held  the  stick  and  stone  up 
before  and  above  him;  for  a  moment  his  eye  was  fixed  upon 
the  stone,  and  we  can  see  the  light  of  definite  inalterable  pur- 
pose suffuse  his  entire  being;  his  right  hand  drops  to  his  side, 
and  Weak  Hands  is  off  in  his  search  for  both  Lily-white  and 
Brute  Force — and  pray  note  he  has  burned  his  bridges  behind 
him. 

With  rapid  strides  he  walked  in  the  direction  leading  to 
the  giant's  cave,  a  considerable  distance  off.  From  afar  he  de- 
termined that  Brute  Force  was  asleep;  his  snoring  caused  the 
very  ground  to  reverberate  .  Lily-white  sat  beside  the  sleeping 
mass  of  brutality.  When  the  familiar  guttural  sound  of  Weak 
Hands  roused  her  from  her  stupid  fear,  she  looked,  and  in  com- 
pliance with  an  imperative  gesture  from  the  man  with  the  stick 
and  stone,  she  carefully  crawled  a  few  steps  away  from  Brute 
Force,  then  arose  and  walked  to  meet  her  caller. 

Another  guttural  sound  from  Weak  Hands  and  Brute  Force 
opened  his  small  eyes  to  behold  his  pestering  rival  trespassing 
upon  his  preserves.  With  a  roar  that  struck  terror  to  Lily- 
white  and  brought  her  to  a  standstill,  Brute  Force  was  up  and 
at  her  in  a  moment.  He  grasped  her  by  the  hair  and  spun  her 
around  toward  the  cave,  then  he  made  for  Weak  Hands. 

A  hideous  grin  from  his  glutton  face,  his  ponderous,  hairy 
hands  extended  before  him,  he  advanced  toward  the  much 
smaller  Weak  Hands  who  calmly  waited. 

This  irritated  Brute  Force,  he  missed  the  sport  of  chasing 
the  ferret  as  heretofore,  and  it  nonplussed  him  somewhat  to  see 
another  one  of  the  tribe  who  dared  stand  still  while  he,  the 
chief,  was  advancing  bellowing  with  rage. 

The  Giant  reached  out  with  his  right  hand  to  make  short 
work  of  Weak  Hands  when  the  right  hand  of  the  latter  shot 


SEQUENCE    OF    THOUGHT  41 

through  the  air  and  a  crashing  blow  from  the  stick  and  stone 
rendered  the  wrist  of  Brute  Force's  right  arm  a  mass  of  man- 
gled bone. 

The  brute  stopped  in  his  tracks,  confused  for  a  moment 
only,  then,  frothing  at  the  mouth  with  rage,  and  with  his  right 
hand  dangling  uselessly  by  his  side,  he  reached  out  with  his 
left  hand  to  wreak  vengeance  upon  the  interloper.  Again  a 
swift  rise  of  \Yeak  Hands'  right,  a  furiously  fast  traveling,  and 
another  crashing  blow,  and  Brute  Force  was  minus  a  useful 
left  arm  and  plus  two  useless  dangling  members. 

Lily-white  crouched  near  the  cave,  transfixed  with  terror 
and  desire,  and  the  other  members  of  the  tribe  had  been  at- 
tracted to  the  scene  by  the  roars  of  rage  with  which  Brute 
Force  filled  the  air.  They  were  standing  rods  away  and  looking 
on  in  awe  and  fear  and  incomprehension  at  what  they  thought 
was  the  foolhardiness  of  Weak  Hands,  who  alone  seemed  un- 
moved. 

Brute  Force,  his  face  distorted  with  rage  and  pain,  his  eyes 
bloodshot  and  his  hands  dangling  by  his  side,  put  his  mon- 
st  ions  head  forward  and  swayed  toward  this  merciless  physical 
inferior  and  tried  to  butt  Weak  Hands,  as  if  he  would  throw 
him  to  crush  him  with  his  feet.  Weak  Hands  stepped  to  one 
side  and  quickly  turned ;  with  all  his  might  he  swung  his  friendly 
stick  and  stone  and  brought  it  crashing  down  upon  the  skull 
of  the  staggering  hulk.  The  giant's  knees  gave  way  under  the 
ponderous  weight  of  the  trunk.  Another  blow  and  Brute  Force 
had  made  the  earth  tremble  with  his  roar  for  the  last  time. 

Some  of  the  members  of  the  tribe  rushed  up  to  wreak 
vengeance  upon  the  presumptuous  Weak  Hands,  who  smote  the 
foremost  one  a  crashing  blow  upon  the  chest  with  his  weapon. 
The  crowd  fell  back  in  fear,  and  retreated. 

AVeak  Hands  walked  toward  the  giant  and  slowly  touched 
him  with  his  foot.  He  motioned  Lily-white  over  toward  him  and 
placed  Ids  left  arm  around  her  shoulder;  he  slowly  turned  to- 
ward the  onlooking  tribe  and  motioned  them  to  remove  the  body 
of  the  late  chief.  His  gestures  were  obeyed  with  alacrity  and 
he  and  Lily-white  were  left  alone. 

The  stick  and  stone  were  at  his  right  shoulder,  and  she  was 
in  his  left  arm.  She  looked  at  him  and  marveled  and  trembled 


42  CAST    GOLD   AND    rOUCKLAlX    JXJ,AYS 

and  moved  her  hand  caressingly  across  his  face,  his  chest,  his 
arms.  He  looked  at  her  face,  and  her  breast  and  her  hair,  and 
his  arm  grew  tighter  around  her.  His  breath  came  faster  and 
his  nares  expanded.  Thus  they  stood  for  a  spell — Weak  Hands 
and  Lily-white.  Then  they  raised  their  eyes  to  the  far-off  coun- 
try and  saw  the  sun  go  down  to  its  rest. 

It  calls  for  no  very  great  analytic  power  to  enable  one  to 
discern  how  far-reaching  an  influence  the  sense  of  touch  had 
in  awakening  mental  efforts  within  the  three  characters  in  the 
preceding  sketch,  and  it  requires  no  very  keen  sense  of  judg- 
ment to  realize  that  they  were  variously  influenced  by  the  same 
sense  of  touch. 

To  Weak  Hands  the  accidental  touch  meant  the  awakening 
of  a  mental  effort  which  crystallized  into  coherent  thoughts, 
which  manifested  themselves  in  a  series  of  distinct  physical 
acts,  partly  involuntary  and  automatic,  partly  premeditated, 
and  for  him  ultimately  altogether  beneficial. 

To  Brute  Force,  the  premediated  touch  or  blow  from  the 
stick  and  stone  controlled  by  Weak  Hands  aAvakened  within 
him  mental  effort  of  such  low  order  that  it  crystallized  into 
thought  of  such  poor  rationality,  that  these  thoughts  manifested 
themselves  in  such  irrationally  aggressive  physical  acts  that 
they  brought  to  him  destructive  tactics  from  Weak  Hands  and 
their  destructiveness  increased  with  the  irrational  perseverance 
of  offensive  tactics  on  the  part  of  Brute  Force. 

Thus  the  performance  went  on  until  the  giant  had  fallen 
an  easy  prey  to  the  mind-developing  mental  effort  of  Weak 
Hands,  on  one  side,  and  his  own  mind-disturbing  mental  effort 
on  the  other.  Nor  did  the  cessation  of  the  battle  prove  the  end 
of  .the  series  of  mental  efforts,  crystallizing  thoughts,  and  phys- 
ical acts,  and  again  mental  efforts  and  crystallized  thoughts, 
etc.,  so  far  as  Weak  Hands  was  concerned,  and  through  him  so 
far  as  Lily-white  was  concerned. 

The  moment  his  touch  of  the  weapon  became  premeditated, 
it  was  the  manifestation  of  a  thought  crystallized  from  a  pre- 
vious mental  effort,  and,  in  turn,  roused  mental  efforts  which 
were  secondary,  coordinate  and  deductive,  which  secondary  co- 
ordinate and  deductive  mental  efforts  again  crystallized  into 
coherent  thought,  which  coherent  thought  again  manifested 


SK(,>rKX('E    OF    TIHU'CHT  4.') 

itself  in  distinct  physical  acts.  This  went  on  in  rotation  until 
the  power  of  this  newly  found  friend  to  awaken  within  him 
mind-developing  -desires  for  further  research  in  it  or  with  it 
was  exhausted. 

It  is  quite  safe  to  assume  that  this  stick  and  stone  as  the 
crude  ancestor  of  the  modern  scepter  has  held,  and  is  still 
occupying  a  more  or  less  prominent  place  within  the  cryptic 
mind  of  modern  "Weak  Hands,  with  benefits  to  some,  and  dire 
results  to  others. 

Reading-  and  Its  Influence  to  Coordinate  Action,  Mental  and 

Physical 

The  things  we  see,  the  things  we  hear,  the  things  we  touch, 
result  as  shown  before,  in  what  we  think,  and,  as  also  shown 
In-fore,  in  the  things  we  do. 

Xow,  it  is  so  with  some  that  the  things  they  see,  hear 
and  touch,  rouse  them  to  mental  efforts  which  crystallize  into 
thoughts,  which  thoughts  manifest  themselves  in  the  physical 
act  of  writing  or  recording  what  they  saw,  heard,  and  touched. 

Thus  are  things  recorded,  that  their  contemporaries  or 
posterity  may  learn  of  what  the  recorders,  or  writers,  saw, 
heard,  and  touched,  or  by  which  they  were  seen,  heard,  or 
touched. 

Seven  thousand  years  of  this  world's  history  have  been 
recorded  correctly  and  incorrectly. 

A  great  many  of  the  records  are  mere  guesswork,  and  were 
made  long  after  the  events  to  be  recorded  were  supposed  to 
have  taken  place.  It  is  only  the  last  few  centuries  that  can  boast 
of  absolute  authenticity  of  chronicled  past  happenings,  because 
it  is  only  a  few  centuries  ago,  that  it  became  easy  to  record 
things  in  so  multiple  a  way  and  in  so  comprehensible  a  manner 
that  no  doubt  was  left  as  to  the  things  said  to  have  happened, 
having  really  happened. 

Thus  the  invention  of  the  printing  press  easily  stands  up- 
permost and  foremost  in  the  rank  of  causes  for  properly  under- 
standing why  humanity  does  not  understand. 

This  is  not  written  with  any  attempt  to  make  it  seem  clever 
—that  is  a  bitter  pill,  which  leaves  a  hitter  taste,  and,  sugar  off, 
the  bitterness  remains. 


44  CAST  GOLD  AND  PORCELAIN  INLAYS 

Millions  of  books  have  been  written  by  as  many  writers 
upon  as  many  subjects,  and  these  books  have  been  read  by  many 
more  millions  of  readers,  sometimes  for  mere  amusement,  some- 
times in  an  ardent  search  for  truth. 

It  is  only  natural  that  these  readers  should  have  been  in- 
fluenced in  their  directions  and  modes  of  thinking  by  the  crys- 
tallized thoughts  of  the  various  authors  and  since  a  man's  acts 
are  what  he  thinks,  it  follows  that  the  work  done  by  the  readers 
was  enhanced  or  adversely  modified  by  what  they  read. 

Thus  we  see  at  a  glance  how  great  a  responsibility  they  who 
write  assume. 

The  sum  total  of  all  science  is  already  existing  in  this 
universe,  merely  awaiting  our  discovery  of  it  in  its  affirmative 
actions.  That  is  proved  by  the  wonderful  cosmic  progression 
which  is  taking  place  in  a  definite,  unhurried,  and  absolutely 
irresistible  manner,  and  tends  always  towards  a  more  complete 
evolution  to  a  higher  type  from  a  lower  one. 

The  more  complete  a  realization  an  author  has  of  this  won- 
derful cosmic  urge,  the  more  valuable  in  the  end  will  be  his 
writings  to  his  readers. 

It  may  be  a  novel,  a  treatise,  a  catecism,  or  a  dogma ;  all 
these  are  valuable,  if  the  author  realize  the  fundamental  cor- 
nerstone of  all  knowledge  to  be  the  clear  demonstration  of  the 
working  of  all  for  each,  and  of  each  for  all.  In  this  manner 
only  can  he  bring  home  to  his  reader  a  full  recognition  of  the 
interdependence  of  all  media  in  the  universe,  and  upon  a  com- 
plete recognition  of  this  interdependence  must  rest  the  basic 
mental  effort  of  his  work. 

A  great  many  books  have  been  written  with  an  absolute 
disregard  to  this  truth,  and  often  in  direct  opposition  to  it,  a 
great  many  of  these  books  have  been  read  and  accepted  by  the 
readers  as  a  guide  for  subsequent  thinking  and  hence  actions. 
Thus  the  errors  of  one,  have  become  the  misdeed  of  the  many, 
and  the  misdeeds  of  the  many  have  grown  into  a  plague  for  the 
whole. 

How  often  do  we  hear  the  words,  "I  should  have  been 
earlier,  if  I  had  not  lost  my  way,"  and  how  infrequently  do  we 
realize  the  significance  of  this  utterance. 

It  is  an  absolute  fact  that  untold  men  and  women  have  lost 


SEQUENCE    OF    THOUGHT  4.") 

tlieir  way  on  their  road  to  complete  evolution  from  a  lower  to 
a  higher  type,  not  permanently,  for  that,  because  of  the  irre- 
sistible law  of  cosmic  progression,  is  impossible;  but  for  the 
time  being,  and  they  will  arrive,  undoubtedly.  They  will 
awaken  to  throw  off  the  retarding  blanket  of  mind-disturbing 
mental  efforts  and  strike  out  into  the  broad  highway  of  clear 
understanding.  They  w.ill  come  under  the  influence  of  mind- 
developing  mental  efforts  and  they  will  arrive,  for  can  we  not 
recall  the  sentence,  "I  shall  light  a  candle  of  understanding 
within  their  hearts,"  which  means  that  they  who  have  eyes  shall 
see,  and  they  who  have  ears  shall  hear ! 

It  does  not  matter  how  many  beings  are  at  present  in  the 
grasp  of  misunderstanding;  that  is  it  does  not  matter  so  far 
as  the  ultimate  result  is  concerned. 

The  one  regrettable  fact  is  that  these  beings  are  so  to 
speak  in  bondage  so  long  as  they  persist  in  their  course.  Ulti- 
mately they  will  turn  about  and  reach  the  destination  assigned 
for  humanity  which  is  complete  evolution.  In  the  interim,  they 
will  have  suffered,  and  will  have  brought  suffering  to  many. 
All  that,  because  one  man  was  blind  and  recorded  the  black  of 
night  and  called  it  the  ray  of  light. 

It  is  incontrovertibly  true,  that  ultimately  we  shall  all  have 
a  correct  understanding  of  the  interdependence  of  all  media  in 
the  universe,  in  spite  of  all  the  erroneous  theories  spread  by  the 
reading  of  hybrid  volumes.  They  shall  be  forgotten,  lost  and 
destroyed  by  the  virulence  of  the  thoughts  they  called  forth, 
for  we  see  that  everything  in  Nature  tends  ever  to  a  fuller 
expression  of  life,  and  life  means  completeness,  and  the  full 
expression  of  life  implies  happiness,  and  happiness  implies  har- 
mony, and  harmony  implies  order,  and  order  implies  proportion, 
and  proportion  implies  beauty,  and  (lest  we  forget)  the  will  to 
call  forth  the  mental  impression,  crystallizing  into  thoughts  on, 
and  of,  beautiful  things;  such  thoughts  later  manifesting  them- 
selves in  our  respective  acts,  while  calling  for  both  mental  and 
physical  activity,  are  in  no  way  hurtful  or  exhausting. 

Thus  we  recognize  the  existence  within  us  of  an  inexhaust- 
ible supply  of  energy  to  oppose  and  surmount  the  deleterious 
and  self-destructive  influence  of  the  secondary,  though  coordi- 
nate, mind-disturbing  and  incorrect  mental  efforts  awakened 


46  CAST  GOLD  AND  POHCKLAIN'  INLAYS 

by  the  mind-disturbing  propaganda  of  the  unfortunate  authors 
of  misfortune  spreading1  thoughts. 

If  a  more  concrete  example  of  the  influence  of  reading  in 
rousing  us  to  mental  efforts  he  required,  I  would  submit  for 
your  consideration,  the  reading  of  Kipling's  "If."  3t  is  in- 
spiring and  powerful,  and  throbs  with  the  essence  of  truth  and 
purpose  and  a  lofty  ideal.  It  will  stir  you  with  its  mighty  pur- 
pose for  humanity's  growth,  and  it  will  awaken  within  you, 
mental  efforts  which  will  crystallize  into  thoughts,  which 
thoughts  will  manifest  themselves  in  your  physical  acts.  You 
will  know  more,  think  more  clearly,  and  work  better;  and  all 
these  enhanced  activities,  though  calling  for  an  apparently  in- 
creased expenditure  of  both  mental  and  physical  effort,  wT,ill 
prove  in  no  way  hurtful  or  exhaustive. 

Again  I  would  submit  for  your  consideration,  Tom  Moore's 
"Veiled  Prophet  of  Khorassan."  It  will  rouse  you  and  thrill 
you,  and  shake  you  and  wake  you,  and  almost  kill  you  with  its 
insane  emotions  of  the  insane  prophet  and  his  benighted  fol- 
lowers. 

It  will  rouse  'you  into  mental  efforts  which  will  crystallize 
into  thoughts,  which  thoughts  will  probably  manifest  themselves 
in  the  physical  act  of  your  nausea.  It  will  leave  you  less  virile, 
more  fretful,  and  almost  consume  you  with  the  fury  of  your 
anger  at  one  of  thousands  who  have  duped  the  world's  inno- 
cents, and  are  still  duping  them  to  the  holy  tune  of  "Blessed  are 
they  that  know  not  and  believe." 

A  Consideration  of  the  Foregoing1  Plus  Our  Ideal 
of  a  Task 

If  \ve  read  the  foregoing  carefully  and  follow  the  trend 
of  the  thought  it  expresses,  we  must  realize  that  usually  our 
thoughts  and  deeds  are  tinged  to  a  great  extent  with  the  hues 
of  the  deeds  of  those  that  have  gone  before,  and  we  realize  also 
that  in  this  manner  are  traits,  habits,  and  usages  formed  and 
confirmed. 

If  that  were  a  fixed  rule  in  the  evolutionary  strife  of  the 
cosmos,  there  would  be  cosmic  repetition  instead  of  cosmic  pro- 
gression, and  there  would  be  no  need  whatever  to  attempt  to 


SKQCKXCI:  or  TiiorciiT  47 

form  a  new  spectral  aspect  of  things  in  general,  an<l  this  part 
of  what  shall  prove  a  recreative  art  in  particular. 

But  this  is  not  a  fixed  rule,  fortunately,  and  the  lixiiy  and 
influence  of  this  rule,  or  rather  tendency,  varies  inversely  with 
the  number  of  humans  that  start  their  tasks,  no  matter  what 
they  he,  from  the  standpoint  of  simple  feeling. 

Xow  what  does  this  mean?  It  means  just  this:  AVe  seek 
to  express  in  our  work  that  which  we  feel  we  would  have  the 
work  he,  and  that  brings  us  to  the  problem  of  attempting  to 
feel  ourselves  to  he  so  possessed  by  our  ideal  of  what  we  wish 
to  do,  that  our  accomplishment  of  the  deed  will  be  a  physical 
manifestation  of  what  our  ideal  of  it  was. 

If  the  sum  total  of  our  efforts  in  this  cosmic  certitude  be 
nothing  but  a  reflection  of  the  mental  efforts,  crystallized 
thoughts,  and  physical  acts  of  those  who  were  here  before  us, 
or  even  here  now,  plus  the  expenditure  of  a  given  amount  of 
energy,  then  the  most  we  can  hope  for  is  to  make  fairly  accurate 
constrnctionists  or  analytic  scientists  of  ourselves. 

But,  if  we  take  what  we  see,  hear,  touch  and  read,  and  care- 
fully absorb  what  is  thus  offered,  and  then,  putting  these  into 
the  background  for  a  moment,  start  our  task  with  an  ideal  of 
what  we  wish  to  accomplish;  in  other  words,  if  we  feel  whai 
is  required,  and  we  have  a  conception,  an  ideal  of  what  the  thing 
that  is  required  must  look  and  act  like;  that  is,  if  we  start 
our  task  from  the  standpoint  of  .simple  feeding,  we  have,  not 
only  the  chance  but  the  assurance,  that  our  work  will  transcend 
the  scope  of  simple  mechanics,  and  it  will,  in  truth,  become 
creative. 

The  interdependence  of  all  media  in  the  universe  makes  it 
<  — ''iitial  that  we  be  able  to  distinguish  absolutely  between  cause 
and  effect;  and  though  an  effect  may,  and  usually  does,  start 
a  train  of  secondary  causation,  our  ideal  of  a  task  must  be  high 
enough  and  its  hold  upon  us  must  be  firm  enough  to  enable  us 
to  see  the  mentally  conceived,  physically  manifest  itself,  devoid 
of  any  limiting  conditions  imposed  by  outside  influences,  of 
what  may  be  an  effect  of  a  secondary  train  of  causation. 

Virtually,  that  is  creation  on  the  level  of  the  human  growing 
in  evolutionary  definition  and  degree. 

For  creation  /s  tltc  inception  of  first  life  from  something 
intangible  into  something  tangible. 


48  OAST  GOLD  AND  PORCELAIN'  INLAYS 

SOME    RATIONAL    AND    ACCEPTABLE    CONCLUSIONS 

We  must  understand  and  accept  in  order  to  understand: 

That  the  creative  effort  of  the  universal  creative  force 
is,  as  said  before,  always  toward  the  evolution  to  a  higher  type 
from  a  lower  one. 

That  we  as  humans,  represent  within  ourselves  every  step 
in  the  evolutionary  efforts  of  the  creative  force  in  its  attempt 
to  advance  from  a  lower  to  a  higher  type. 

That  since  we  are  possessed  of  the  qualities  of  life,  intelli- 
gence and  individual  volition,  we  may  greatly  aid  in  this  ad- 
vance, or  we  may,  in  a  measure,  temporarily  retard  cosmic 
progression  in  the  human,  by  either  doing  what  we  should  not, 
or  not  doing  what  we  should  do. 

That  since  the  creative  force  is  the  source  of  all  creation, 
it  follows  that  no  one  manifestation  of  the  evolutionary  effort 
of  the  creative  force  can  permanently  affect  in  an  adverse  man- 
ner its  laws  of  growth,  tendency,  and  cosmic  progression. 

That  the  acknowledgment  or  the  acceptance  of  the  theory 
of  evolution  does  not  argue  against  inception  of  life  in  a  creative 
sense. 

That  since  the  creative  force  is  the  source  of  all  creation, 
it  must  be  the  source  of  all  first  life  upon  this,  or  any  other 
planet. 

That  it  is  preposterous  to  assume  that  any  man  will  spend 
his  entire  time  developing  any  sort  of  work  with  the  sole  pur- 
pose to  ultimately  destroy  every  evidence  of  his  efforts. 

That  it  is  far  more  preposterous  to  assume  that  the  creative 
force  will  tolerate  conditions  which  tend  to  nullification  of  any 
creative  effort  on  its  part. 

That  the  ultimate  purpose  of  the  creative  force  is  the  per- 
fection of  species  which  are  physical  manifestations  of  its 
varied  activities. 

That,  of  all  these  species,  the  human  is  the  closest  relation 
of  the  creative  force,  because  the  human  possesses,  not  only  the 
quality  of  appreciation  of  the  creative  grandeur,  but  also  the 
power  of  imitation  and  imagination,  and,  to  a  limited  extent, 
origination  or  creation. 

That  the  creative  force  has  displayed  upon  a  stupendous 
scale  the  faculties  of  selection  and  adaptation  of  means  to  ends. 


SEQUKXCi:    OF    TJIOTOHT  49 

Tliat  the  human  possesses  these  faculties  to  a  remarkable 
degree. 

That  the  purpose  of  the  creative  force  toward  the  human 
species  from  the  first  inception  of  its  existence  has  been,  and 
is,  that  of  a  gradual,  but  constant,  evolution  from  helpless  in- 
efficiency to  perfect  type. 

That  perfection  of  type,  to  be  displayed  by  the  human 
species,  implies  a  perfect  equilibrium  of  perfect  organs  which 
shall  make  up  the  physical  body  of  the  human. 

That  when  the  tendency  of  the  creative  force  is  toward  per- 
fection of  type,  that  stage  will  ultimately  be  reached  through 
the  aid  of  the  particular  species  itself. 

That  the  creative  force  of  the  universe  is  at  our  disposal 
in  direct  proportion  as  we  understand  the  determined  laws  of 
growth,  tendency,  and  cosmic  progression,  and  submit  to  them 
in  order  to  transcend  them. 

That  perfection  of  the  human  species  implies  the  elimina- 
tion of  all  disease  of  mind  or  body.  That  it  implies  also  the 
elimination  of  all  economic  or  social  conditions  which  make  the 
presence  of  disease  possible. 

That  any  individual  or  communal  tendency  of  the  human 
species  to  oppose  the  general  evolutionary  progression  to  per- 
fect type  is  effectually  counteracted  by  the  creative  force,  in 
that  it  calls  forth  conditions  which  overwhelm  opposition  or  the 
result  of  opposition. 

That  human  misinterpretation  of  tendency  and  purpose  of 
the  creative  force  is  almost,  if  not  quite,  as  old  as  the  first  spark 
of  intelligence  which  appeared  in  the  genus  homo. 

That  limited  intelligence  was  the  cause  of  this  misinter- 
pretation. 

That  a  misinterpretation  is  an  error. 

That  an  error  is  a  hindrance  in  the  path  of  our  evolutionary 
cosmic  progression. 

That  as  such,  it  is  in  conflict  with  the  tendency  of  the  crea- 
tive force  which  immediately  sets  about  to  call  forth  conditions 
to  overwhelm  the  result  of  the  error  and  the  cause  of  it. 

That  hence,  the  healing  art  is  as  old  as  the  first  error  of 
man. 

That  errors  and  accidents  are  the  primary  causes  of  all 
human  ills,  and  all  accidents  are  errors  of  one  kind  or  another. 


50  CAST  GOLD  AND  PORCELAIN  INLAYS 

That  all  errors  are  traceable  to  tlie  as  yet  incomplete  evo- 
lution of  the  human,  physically  and  mentally. 

And  finally  that  the  complete  evolution  of  the  human,  phys- 
ically and  mentally,  will  he  attained  through  the  properly 
directed  efforts  of  the  humans  themselves,  working  along  and 
in  accord  with  the  universal  laws  of  growth,  tendency,  and 
cosmic  progression. 

The  healing  art  is  as  old  as  the  first  error  of  man. 

The  milestones  that  mark  the  important  events  in  its  ex- 
istence are  the  periodically  determined  incontrovertible  facts, 
which  will  finally  make  out  of  the  art  of  healing  the  science  of 
health  restoration  and  maintenance. 

Dentistry  is  the  art  of  restoring  to  use  and  service  dete- 
riorated oral  organs  and  tissues. 

Dentistry  was,  and  to  a  large  extent  still  is,  a  medley  of 
acts  devised  by  humans  to  counteract  the  breaking  down  of  the 
oral  organs  and  tissues  through  disease  or  accident. 

Dentistry  is  a  part  of  the  healing  art,  and  is  as  old  as  the 
first  error  which  resulted  in  the  initial  oral  or  dental  deviation 
from  the  physiologic,  or  normal. 

The  milestones  that  mark  the  important  events  in  its  de- 
velopments are  the  periodically  determined  incontrovertible 
facts,  which  will  finally  make  out  of  the  art  of  dentistry,  the 
science  of  tooth  and  oral  health  restoration  and  maintenance, 
with  emphasis  on  the  maintenance. 

Millions  of  the  human  species  are  as  yet  in  the  grasp  of 
ills  resulting  from  errors  of  judgment,  and  opposed  to  these 
millions  are  a  handful,  who,  under  ATeritable  inspiration,  are 
doing  the  work  of  the  creative  force  in  bringing  about  con- 
ditions which  will  ultimately  make  man  understand  that  he  is 
headed  in  the  direction  of  evoluting  into  a  perfect  manifestation 
of  the  creative  force;  that  is,  of  evoluting  into  that  which  it  feels 
itself  to  be,  to  wit:  a  creative  force.  That  handful  of  men, 
working  against  what  would  seem  to  be  insurmountable  obsta- 
cles, will  be  triumphant  in  the  work  in  which  they  are  the 
fortunate  instruments. 

If  we  reflect  for  a  moment,  we  shall  find  this  very  simply 
and  very  easily  proved. 

We  understand  that  no  one  manifestation  of  the  creative 
force  in  the  universe.  Its  very  name  implies,  that  .and  the  re- 
growth,  tendency,  and  cosmic  progression. 


SEQUKXCK    OK    TllorcTFT  ")L 

We  understand  also  that  man  is  one  of  the  manifestations 
of  the  varied  activities  of  that  creative  force. 

If  we  understand  that  even  in  their  most  active  periods, 
human  ills  can  he  hut  a  part  of  man,  that  is  but  a  part  of  one 
of  the  manifestations  of  the  creative  force,  and  no  primary  part 
at  all,  then  we  must  realize  how  simple  and  predestined  is  the 
final  conquest  of  all  influences  which  would  tend  to  retard  com- 
plete evolution  along,  and  in  accord  with,  the  laws  of  growth, 
tendency,  and  cosmic  progression. 

Xo  one  will  dispute  that  the  creative  force  is  the  greatest 
force  in  the  universe  .  Its  very  name  implies  that,  and  the  re- 
sults of  its  efforts  sustain  that  assertion,  and  it  is  concrete 
enough  in  its  manifestation  to  enable  even  the  uninitiated  to 
become  aware  of  its  presence.  We  may  even  have  a  very  con- 
crete example  to  illustrate  the  final  victory  for  evolution  over 
cosmic  repetition. 

If  two  forces,  acting  in  opposite  directions,  exert  their 
efforts  upon  a  movable  body,  the  resultant  will  be  the  difference 
between  the  two  forces,  and  the  body  will  travel  in  the  direction 
of  the  greater  force. 

If  this  holds  true  in  simple  mechanics,  how  powerfully  over- 
whelming must  finally  be  the  triumph  of  the  creative  force  in 
overcoming  the  effects  of  human  error  upon  humans. 

This  also  explains  why  it  is  possible  for  a  few  men  to 
counteract  conditions  brought  about  by  the  acts  of  untold  num- 
bers. The  few  are  working  along,  and  in  accord  with,  the  laws 
of  growth,  tendency,  and  cosmic  progression  of  the  creative 
force. 

It  may  take  a  dozen  years  or  a  dozen  centuries  for  the  cre- 
ative force  to  accomplish  its  work,  or  it  may  take  a  thousand 
centuries.  "Who  knows  ?  That  the  work  will  be  accomplished 
is  as  certain  as  if  it  were  a  finished  deed  at  present. 

The  problem  that  tlieu  irho  desire  to  ivork  with  tlie  creative 
force  are  face  to  face  irith,  Is,  how  can  they  best  accelerate 
tJ/e  irork  <>f  tiiis  creative  force:  and  since  that  problem  is  uni- 
versal, t]ie  solution  must  be  one  capable  of  universal  application; 
and  this  means  tJiat  if  ice  are  engaged  in  any  human  error- 
correct  in  (/  u-ork.  ire  must  at  tempt  to  so  do  our  work  as  to  make  a 
recurrence  of  tie  error  impossible,  or  as  nearlu  that  as  possible. 


CHAPTER  II 


The  teeth,  as  organs  of  incision,  prehension,  mastication, 
and  as  accessories  of  vocalization,  speaking  or  singing,  have 
these  varied  functions  to  perform.  To  be  best  suited  for  this 
task,  nature  has  caused  them  to  acquire,  in  the  process  of  their 
development,  certain  qualities  and  certain  definite  structural 
shapes.  Any  deviation  from  their  macroscopic  normality  and 
their  microscopic  organization,  causes  a  lack  of  functional  effi- 
ciency and  interferes  with  their  normal  contribution  toward  the 
maintenance  of  vital  balance.  Hence  all  dental  efforts  should 
be  directed  toward  a  re-creation  of  macroscopic  and  microscopic 
acceptableness  of  these  organs  when  they  require  our  attention 
at  all. 

In  health,  gums,  teeth,  in  fact  all  organs  in  the  animal  body, 
perform  their  function  as  a  matter  of  grateful  exercise  without 
undue  consciousness  on  the  part  of  the  animal  contributing  to 
the  maintenance  of  an  efficient  organization,  in  which  the  income 
is  greater  than  the  expenditure  to  obtain  this  income;  but,  in 
order  to  obtain  such  a  condition,  there  must  be  perfect  inter- 
play of  all  organs  making  up  the  animal  body,  and  the  first 
requisite  for  perfect  interplay  is  absolute  lack  of  interference 
by  one  organ  with  any  other  one  or  more  organs. 

We  have  had  our  lectures  on  anatomy  of  the  teeth,  and  we 
know  what  they  look  like,  or  should  know.  We  have  had  our 
lectures  in  physiology,  and  we  know  what  the  gums  and  the  ad- 
joining structures  look  like  in  a  healthy  mouth;  we  have  like- 
wise also  been  able  to  learn  the  beautiful  lessons  of  occlusion. 
All  these  should  have  given  us  a  picture  of  healthy  conditions 
not  easily  erased.  And  it  is  this  picture  we  must  ever  seek  to 
re-create,  and  we  can  not  re-create  it  en  masse  unless  we  re- 
create it  in  spots  in  individual  teeth  and  their  surrounding 
gingivae. 

Let  me  call  your  attention  to  a  remarkable  realization, 

52 


OF    THE    TEKT11  53 

which  must  come  to  all  of  us  who  would  endeavor  to  obliterate 
the  effects  of  human  error  upon  the  human  system.  Every  mol- 
ecule that  makes  up  the  human,  or  animal,  or  plant  body  is  in 
a  state  of  constant  rhythmic  movement,  which  motion  is  in  def- 
inite geometric  relation  to  the  motion  of  the  molecules  neigh- 
boring it,  which  warrants  the  conclusion  that  the  molecules 
influence  one  another  by  their  rhythmic  movements  to  the  point 
of  causing  corresponding  geometric  gyrations  in  each  other. 

This  is,  of  course,  not  a  matter  of  first  causation;  that  is, 
not  a.  matter  of  life  inception,  but  rather  a  matter  of  life  main- 
tenance by  virtue  of  the  maintenance  of  the  equilibrium. 

If  we  conceive  the  animal  as  a  delicate  clock  or  watch,  for 
example,  we  may  obtain  a  concrete  illustration  of  the  interrela- 
tion of  all  the  organs.  Let  us  assume  that  we  are  accelerating 
the  minute  hand  of  a  clock  by  slowly  rotating  it  to  the  right 
(take  out  your  watch  and  make  the  example  more  concrete); 
we  can  readily  understand  that  we  shall  by  this  act  influence  the 
entire  mechanism  to  a  more  accelerated  motion,  and  that  this 
motion  will  be  in  definite  relation  to  the  intensity  of  the  acceler- 
ator force,  and  that  there  will  be  a  definite  rhythmic  and  geo- 
metric relation  between  the  motion  of  each  separate  piece  of 
mechanism  which  makes  up  the  whole  of  the  clock. 

If  we  remove  the  influence  of  the  accelerator  force,  an 
immediate  rhythmic  and  geometric  adjustment  takes  place,  and 
the  hands  of  the  clock  proceed  to  travel  at  the  original  speed. 
This  may  be  called  a  stimulating  interference  with  the  mech- 
anism, and  results  in  a  greater  amount  of  work  or  activity  being 
done  in  a  given  time  than  the  apparatus  was  intended  for.  If 
\ve  no\v  place  the  hour  hand  at  the  numeTal  9  and  the  minute 
hand  at  the  numeral  3  and  suspend  a  minute  weight  from  the 
extremity  of  the  hour  hand,  we  shall  have  an  inhibitory  inter- 
ference with  the  mechanism,  resulting  in  a  given  amount  of 
energy  doing  a  smaller  amount  of  the  work  than  the  apparatus 
was  intended  for;  the  spring  will  uncoil  or  attempt  to  uncoil  at 
the  same  ratio,  but  its  effect  upon  the  wheels,  and  through 
these  upon  the  hands,  will  be  less  marked  than  before;  again 
there  will  be  a  rhythmic  and  geometric  readjustment  to  normal 
when  the  inhibitory  interference  is  removed. 

Up  to  a  certain  point,  these  experiments  may  be  repeated 


54  CAST   GOLD    AND    PORCELAIN    INLAYS 

without  .impairing1  tlie  inherent  virility  of  the  spring,  hut  as 
soon  as  the  point  of  impairment  is  reached,  a  rhythmic  re- 
adjustment becomes  impossible,  a  lack  of  perfect  interplay  man- 
ifests itself,  resulting  in  a  heedlessness  of  expression;  the  parts 
interfere  with  one  another,  and  a  great  deal  of  energy  is  ex- 
pended to  bring  about  a  result;  work  which  is  as  unsatisfactory 
as  it  is  unreliable. 

For  the  purpose  of  elimination  of  mechanical  shock  to  the 
nervous  system  during  mastication,  and  for  the  purpose  of  en- 
hancing the  vibrating  effect  produced  during  vocalization,  be 
it  singing  or  speaking,  also  for  the  purpose  of  minimizing  me- 
chanical injury  to  the  teeth  themselves,  the  latter  are  held  in 
their  bony  sockets  through  the  intermediary  agency  of  an  elas- 
tic membrane,  which  is  so  disposed  beneath  and  around  them, 
as  to  fairly  hold  them  suspended  in  a  resilient  cushion. 

The  elastic  fibers  composing  the  membrane  dispose  them- 
selves longitudinally,  diagonally,  transversely,  and  circularly 
around  the  teeth;  they  interlace  with  the  periosteum  and  with 
the  gum  tissue,  and  thus  during  the  exercise  of  dental  function 
they  effect  an  increase  of  circulation  into  the  surrounding  parts, 
which  constantly  brings  fresh  nourishment  to  these  tissues. 

The  very  structure  of  this  elastic  membrane  and  its  pecu- 
liar function  precludes  the  possibility  of  abundant  blood  supply 
and  makes  it  a  ready  prey  to  inhibitory  interference.  Such  in- 
hibitory interference  may  be  brought  about  by  impaction  of 
foods  into  what  are  known  as  interdental  spaces  or  by  the  ac- 
cumulation of  calcific  material  known  as  tartar,  either  upon  or 
around  the  neck  of  the  tooth,  or  upon  portions  of  the  root.  The 
impaction  of  food  into  the  interdental  spaces  may  be  caused  by 
the  malrelation  of  the  adjoining  teeth  (malocclusion)  or  by  the 
improper  restoration  of  approximal  surfaces  of  teeth  calling  for 
dental  attention.  An  inhibitory  interference  may  also  be 
brought  about  by  a  break  in  the  continuity  of  surface  upon  a 
tooth  in  the  region  mentioned.  A  tooth  may  be  inlayed  and  a 
portion  of  the  inlay  material  may  have  been  left  extending 
beyond  the  margin  of  the  cavity. 

If  pressure  be  exerted  upon  any  one  or  two  teeth  in  the 
mouth,  the  pressure  will  be  transmitted  to  all  the  surrounding 
structures,  and  through  them  to  all  other  teeth  in  the  same 


FUNCTIONS    OF    THE    TEETJI  .).) 

mouth  iii  a  series  of  rhythmic  waves  or  undulations  of  varying 
degrees,  changing  the  physical  outline  of  the  surrounding'  struc- 
tures in  every  direction.  Upon  the  cessation  of  the  pressure  a 
rhythmic  and  geometric  readjustment  will  take  place  in  these 
tissues  and  a  return  to  a  condition  of  comparative  equilibrium 
obtains.  Where  there  are  no  inhibitory  interferences,  that  is 
where  the  relation  of  the  teeth  is  correct,  as  to  position,  con- 
dition and  form,  these  pressure-induced  waves  or  undulations 
may  take  place  ad  infinitum  with  beneficial  results,  because  un- 
der a  correct  condition,  intermittent  pressure  is  the  essential 
stimulating  interference  inducin<i  an  increase  of  circulation, 
bruif/inf/  irith  it  a  fresJi  supply  of  nutriment  essential  to  life 
maintenance. 

AYlien  inhibitory  interferences  are  present,  that  is,  when  the 
relation  of  the  teeth  is  not  correct  as  to  position,  condition,  and 
form,  each  pressure  exerted  upon  the  teeth  during  mastication 
causes  the  same  series  of  waves  or  undulations  in  the  soft  tissues 
surrounding  them,  but  each  wave  or  undulation  causes  these  tis- 
sues to  come  in  contact  with  injuring  or  bruising  obstructions, 
and  the  rhythm  of  recoil  or  readjustment  is  first  interfered  with 
and  ultimately  destroyed. 

Poorly  executed  inlay  restorations  may  be  classed  as  in- 
hibitory interferences  with  the  free  and  unhampered  undulating 
and  very  essential  excursions  of  the  soft  tissues  surrounding 
the  teeth.  They  produce  states  not  conducive  to  the  health  of 
the  individual,  and  are,  therefore,  incorrect  dental  conditions; 
and  any  dental  operation  that  will  entirely  eliminate  them  will 
be  an  operation  conducive  to  the  health  of  the  individual,  and, 
therefore,  a  correct  dental  operation. 

All  tissues  must  be  exercised,  or,  rather,  they  must  have 
the  freedom  to  indulge  in  such  exercise  as  they  need,  and  all 
tissues  of  all  organs  need  exercise  to  keep  them  from  under- 
going atrophic  changes.  Hence  anything  which  will  interfere 
with  the  free  and  unhampered  undulations  of  the  gum  tissues,  by 
any  means  whatever,  results  in  pathologic  conditions  by  bring- 
ing about,  first,  a  lethargic  state  in  the  tissue;  second,  a  dimi- 
nution in  vasomotor  action,  because  of  lack  of  restimulation; 
third,  an  accumulation  of  waste  material  in  the  cellular  and 
intercellular  substance,  resulting  in  a  rapid  death  of  cells; 


.')()  CAST  GOLD  AND  PORCELA1X  IXLAVS 

fourth,  an  atrophy  or  loss  of  tissue,  resulting  in  a  physical 
change  which  makes  it  difficult  to  maintain  a  hygienic  balance. 

We  may  stimulate  life  processes  and  thus  for  a  time  induce 
a  greater  degree  of  livingness. 

We  may  do  this  by  relying  on  external  extraneous,  foreign, 
therapeutic  agents  which  will  act  directly  upon  certain  organs 
and  drive  them  unmercifully  to  greater  activity,  leaving  them 
exhausted  in  the  end ;  or  we  may,  by  means  of  air,  water,  proper 
food,  and  careful  exercise,  which  brings  about  intermittent 
pressure,  induce  a  constant  current  of  restimulation,  which  will 
activate  the  life  processes  to  greater  expression,  and  so  in  time 
make  them  the  source  of  the  restimulating  factor. 

Life,  in  the  abstract,  general,  or  universal,  unlimited  sense, 
is  a  complete  cycle  of  such  activities  with  the  restimulating  fac- 
tors inherent  in  the  activities  themselves,  so  in  a  sense  these  ac- 
tivities and  life  are  synonymous. 

Life,  in  the  concrete,  the  limited,  the  personal,  or  particular 
sense,  is  a  complete  cycle  of  such  activities  with  the  restimulat- 
ing factors  inherent  in  the  activities  themselves,  but  to  the 
individual,  in  a  constantly  less  appreciable  degree,  and  hence 
producing  a  constantly  diminishing  result  or  activity. 

Like  begetting  like,  this  diminished  activity  will  induce  re- 
stimulating  factors  of  minor  influence  upon  the  life  processes, 
the  latter  will  become  sluggish  and  metamorphosis  sets  in. 

Thus  we,  as  individuals,  are  subject  to  the  law  of  change; 
we  are  not  and  can  not  expect  to  be,  permanent  fixtures  of  the 
great  cosmos  forever  expressing  itself  in  the  creation  of  new 
centers  or  vehicles  for  the  display  of  its  endless  energy. 

For  the  reasons  stated  above,  all  human  work  is  limited 
and  transitory,  that  is  not  permanent  in  its  effects  or  results. 
The  things  we  do  are  as  much  subject  to  change  or  metamor- 
phosis as  we  ourselves  are.  This  applies  particularly  to  our 
endeavors,  when  they  are  concerned  with  attempts  to  prevent 
or  inhibit  the  reduction  of  that  cycle  of  our  activities  which 
are  synonymous  with  life. 

We  are  forever  falling  short  of  our  ideal  of  a  task  when 
our  task  consists  in  an  effort  to  balance  income  and  expenditure 
of  human  energy,  and  it  will  ever  be  so,  no  matter  how  we  may 
improve  our  relations  between  our  vegetative  and  objective 


IT. XC'TIOXS    OF    THE    TEETH  57 

Life,  or  how  much  we  may  learn  of  the  mysteries  of  the  bio- 
chemical life  processes  themselves. 

It  is  equally  true  that  constant  effort  for  correct  under- 
standing of  these  things  must  result  in  improved  conditions, 
which  will  enable  us  to  husband  the  now  vastly  dissipated 
energy,  ami  so  prolong  our  activities  and  usefulness  to  a  con- 
stantly growing  degree.  Intuitively  we  are  all  aware  that  this 
is  true,  the  best  proof  of  it  being  that  we  are  in  constant  search 
for  means  of  so  improving  remedial  efforts  for  our  patients,  that 
they,  the  efforts,  will  result  in  a  harmonious  interplay  of  the 
intact  functionating  organs  and  the  artificial  work. 

\\V  must,  therefore,  face  the  self-evident  proposition,  that 
the  cruder  our  remedial  efforts  are,  whatever  organ  wre  may  be 
working  upon,  whatever  our  sphere  of  activity,  whether  it  be 
general  medicine,  surgery,  or  the  specialized  field  of  dentistry, 
and  all  its  kindred  divisions,  the  less  acceptable  will  the  results 
l>e  to  the  other  functioning  organs;  this  means  immediate  rebel- 
lion on  their  part;  and,  unless  the  cause  be  removed,  must  result 
in  a  physical  state  which  is  physiologically  minus  and  patholog- 
ically plus:  conversely,  the  more  finished  or  refined  our  efforts 
are,  the  more  acceptable  will  the  results  be  to  the  other  function- 
ing organs. 

A  finished  or  refined,  remedial  effort,  in  behalf  of  any  organ, 
implies  a  knowledge  of  its  individual  and  relative  anatomy  or 
physical  relationship,  and  a  comprehensive  understanding  of 
the  physiologic  functions  of  that  organ. 

This  brings  us  up  to  the  affirmation  that  teeth  have  func- 
tions (plural  used  advisedly)  and  a  careful  enumeration  and  a 
critical  classification  of  these  functions  are  now  in  order. 

We  may  now  record  the  truth  that  the  so-called  masticatory 
apparatus  is  not  a  separate,  distinct,  and  independent  part  of 
the  human  organism,  but  a  functioning  multiple  member,  or 
cog,  of  a  very  complex  ifriWocosm,  in  the  maintenance  and  pres- 
ervation of  which  it  plays  a  very  important  part.  The  so-called 
masticatory  apparatus  is  not  a  simple  functioning  member 
of  this  complex  machine,  but  is,  in  itself,  a  very  complex  com- 
ponent, in  that  it  comprises  many  organs  diversely  endowed 
with  specialization. 

The  thing  that  suggests  itself  first  in  my  mind  in  regard 


58  CAST   GOLD    AXD    PORCELATX    INLAYS 

to  tooth  function  is  tlie  reciprocal  functions  of  tlie  teeth ;  recip- 
rocal because  they  do  some  things  for  the  organism  which  does 
some  things  for  them. 

Since  every  organ  of  the  body  passively  and  actively  ex- 
ercises such  functions,  these  may  be  called  the  reciprocal  func- 
tions, and  must  be  classified  as  the  passive  and  active  reciprocal 
functions  of  the  special  organs. 

PASSIVE  RECIPROCAL  FUNCTIONS 

The  passive  reciprocal  functions  of  the  teeth  are  defensive, 
cosmetic,  developmental,  and  phonetic.  (See  Fig.  1.) 

The  defensive  functions  depend  upon  the  gross  anatomy 
of  the  teeth;  that  is,  they  are  so  shaped  as  to  prevent  injury 
to  the  soft  tissues  surrounding  and  supporting  them. 

The  cosmetic  functions  depend  upon  the  gross  anatomy, 
geometric  harmony,  and  the  biochemisry,  of  the  teeth.  They 
must  be  in  harmony  with  other  features  of  the  face,  and,  by 
correct  growth,  influence  the  other  features  of  the  face  to  har- 
mony, thus  also  partly  exercising  the  developmental  function. 

The  phonetic  functions  depend  upon  the  gross  and  micro- 
scopic anatomy  of  the  teeth  and  their  position  relative  to  each 
other.  That  is,  they  must  not  only  be  of  a  shape  and  relation 
conducive  to  clear  enunciation,  but  also  of  a  texture  insuring 
the  proper  degree  of  resonance  and  vibration.  The  latter  part 
of  this  function  we  can  unfortunately  not  restore  by  artificial 
means. 

ACTIVE  RECIPROCAL  FUNCTIONS 

The  active  reciprocal  functions  of  the  teeth  must  be  further 
classified  into  general  and  special. 

The  general  functions  are  cardioauxiliary  or  yasoauxiliar\ . 
and  symptomatic. 

The  cardioauxiliary  or  vaso auxiliary  function  consists  in 
the  restimulating  effect,  which  the  mobility  of  the  teeth  has 
upon  the  circulation  of  the  structures  in  which  they  are,  and 
with  which  they  are  resiliency  joined. 

By  virtue  of  this  mobility,  they  induce  a  rhythmic  inter- 
mittent pressure  which,  inimical  to  end  tissue  stasis,  brings 


J-TNCTIOXS    OF    Till-:    TKKTJI 


59 


ExOGENCOS    (  I 


DEFENSIVE    PASSIVE 
RECIPROCAL  FUNCTIONS 


o 

I/       GENERAL  ACTIVE  RECIPROCAL  FUNCTI 


SYMPTOMATIC   f         f          f 

(OBJECTIVE)  G/EMER*L  RECIPROCAL  FUNCTION 


;4  4  't-\  4,    > 

/  /  «Wfc 


INCISION 

Fig.  1. — Diagram  showing  reciprocal  functions  of  the  teeth. 


60  CAST    GOLD    AND    POKCELAHST    INLAYS 

about  a  constant  change  of  the  nutrient  elements  traversing  the 
nutrient  channels  of  these  tissues. 

The  symptomatic  functions  must  be  subdivided  into  struc- 
tural and  positional. 

The  structural  symptomatic  functions  may  be  indicaitve  of 
some  congenital  or  acquired  constitutional  anomaly;  such  as, 
Hutchinson's  teeth,  thyroidal  disbalance  (as  illustrated  in  teeth 
easily  attacked  by  caries),  or  in  the  presence  of  a  marked  pro- 
creative  urge,  often  bordering  on  lack  of  sexual  equilibrium,  as 
illustrated  in  canines  of  decided  prominence  and  marked  pre- 
hensile formation,  reflecting,  perhaps,  the  animalistic  trend  of 
the  individual  in  whom  very  frequently  also  are  to  be  found 
small  suprarenal  bodies  with  narrow  cortex,  demonstrating, 
perhaps,  a  greater  procreative  and  a  less  intellectual  mission  in 
the  cosmic  scheme. 

The  positional  symptomatic  functions  deal  with  the  mal- 
position of  different  teeth  in  the  maxilge  and  mandible,  and  are 
valuable  diagnostic  determinators  in  that  they  thus  unerringly 
point  to  pituitary,  gonadial,  thyroidal,  and  adrenal  disturbances 
which  would  otherwise  be  most  obscure. 

The  special  active  reciprocal  functions  of  the  teeth  are 
communal  and  individual. 

The  communal  special  reciprocal  functions  of  the  teeth  are 
alimentary  and  inhibitory. 

The  alimentary  functions  consist  in  the  part  they  all  play 
in  the  preparation  of  certain  foods  for  the  process  of  digestion. 

The  inhibitory  functions  consist  in  the  physical  relation- 
ship of  the  teeth  or  their  relative  apposition  mesio-distally  in 
particular,  so  as  to  retard,  or  limit,  the  laterorotary  motion  they 
acquire  when  in  use. 

The  individual  functions  are  those  of  incision,  prehension, 
mastication,  and  trituration,  and,  in  the  sequence  enumerated, 
involve  the  incisors,  canines,  bicuspids,  and  molars. 

Since  all  functions  are  recriprocal,  there  can  be  no  fixed 
rule  or  line  of  demarcation  as  to  where  one  stops  and  the  other 
begins. 

All  these  enumerated,  classified  and  dissected,  present  them- 
selves vividly  at  some  point,  the  height  of  the  particular  func- 


FUNCTIONS    OF    THE    TEETH  61 

tional  expression,  to  gracefully  and  gradually  merge  or  lose 
themselves  in  those  which  follow. 

Thus  we  have  an  interplay  of  parts  devoid  of  harsh  or 
interruptive  demarcations.  A  pleasing  harmony  as  expressed 
in  coordinate  effort,  salubrious  in  effect;  a  song  of  work  as 
marvelously  planned  as  it  is  symphonically  expressed  in  living- 
ness,!  and  yet  more  livingness,  to  the  glory  of  the  mind  that 
bade  it  come  into  being. 

SUMMARY  FOR  CHAPTER  II 
The  Functions  of  the  Teeth 

1.  What  is  meant  by  the  reciprocal  functions? 

2.  How  are  the  reciprocal  functions  classified? 

3.  Name  the  passive  reciprocal  functions  and  define  each. 

4.  How  are  the  active  reciprocal  functions  classified? 

5.  Define  the  cardioaxiliary  or  vasoauxiliary  functions. 
(5.  Subdivide  and  define  the  symptomatic  functions. 

7.  Define  the  following  functions:  communal,  alimentary,  inhibitory,  in- 
dividual. 


CHAPTER  III 
THE  CAST  GOLD  INLAY 

Human  teeth  decay  and  become  a  source  of  discomfort  and 
danger  unless  they  can  be  restored  by  therapeutic,  operative, 
and  mechanical  means. 

The  foregoing  is  a  statement  of  facts  that  no  amount  of 
argument  can  dislodge.  It  is  universally  known,  so  far  as  our 
profession  is  concerned,  and  it  stands  as  a  comprehensive  reason 
for  our  entire  and  particular  field  of  endeavor.  It,  therefore, 
presents  a  proper  basis  or  fundamental  statement  for  this 
volume,  although  this  volume  concerns  itself  with  only  that 
part  of  corrective  endeavor  known  as  inlay  work  or  the  cemented 
filling. 

This  work,  that  is,  the  restoration  of  a  broken-down  tooth 
by  means  of  a  cast  gold  inlay,  may  be  broadly  defined  as  a  den^ 
tal  operation. 

Any  operation  may  be  correct  or  incorrect;  and  a  correct 
dental  operation  may  be  defined  as  one,  the  result  of  which  is 
conducive  to  the  health  of  the  individual  upon  whom  the  opera- 
tion is  performed.  We  understand  by  the  term  health,  the  main- 
tenance of  that  vital  balance  which  is  expressed  by  the  normal 
functioning  of  all  organs  which  compose  the  human  body. 

Inlay  work  may  be  divided  into  two  classes,  metallic  and 
nonmetallic. 

Metallic  inlays,  which,  because  of  their  importance  as  tooth- 
restorers,  shall  have  first  place,  are  those  that  are  made  of 
gold  or  any  alloy  in  which  gold  or  other  suitable  metal  pre- 
dominates. 

The  making  of  metallic  inlays  may  be  brought  about  by  the 
swaging  or  casting  method.  The  former  are  so  imperfect  and 
have  proved  so  unsatisfactory  that  they  are  becoming  obsolete 
and  will  not  be  considered;  and  since  gold,  as  a  rule,  predomi- 
nates in  the  cast  metallic  inlay,  it  will  hereafter  be  referred  to 
as  *he  cast  gold  inlay. 

62 


CAST    GOLD    IXLAY  63 

A  cast  gold  inlay  may  be  defined  a*,  a  max*  of  molten 
metal  under  definite  </aseons  pressure,  forced  into  <uid  shaped 
in  a  special  wold,  so  that  it  trill,  upon  cooling  or  crystaUissmgt 
accurately  fit  into  the  cavity  of  the  tootJi  from  irliich  the  ira.r 
pattern  embedded  in  the  mold  iras  taken,  and  that  cool  mass 
of  metal  shall  in  outline  and  eminences  so  conform  to  the  out- 
lines and  eminences  of  that  particular  tooth,  and  opposing  and 
adjoining  teeth,  if  Iliere  be  any,  that  it  shall  form  an  acceptable, 
anatomic,  co)nplement  to  the  tootli  ref/idr'nig  restoration,  and 
if  shall  make  that  tooth  macroscopicaUy  perfect. 

In  short,  then,  a  ca^st  gold  Inlay  is  an  accurate  metallic 
complement  to  the  macroscopic  anatomy  of  a  brokcn-doirn  tooth. 

The  process  of  restoring  broken-down  teeth  by  means  of 
cast  gold  inlays  consists  of  a  series  of  steps  or  operations  which 
in  their  proper  sequence  may  be  enumerated  in  the  following- 
order  : 

1.  Selection  or  election  of  the  case. 

2.  Preparation  of  the  cavity. 

3.  Selection  of  the  proper  wax  and  the  making  and  carving 
of  the  wax  model  by  means  of  the  direct  or  indirect  method. 

4.  Taking  an  impression  of  the  cavity  and  making  a  die  for 
procedure  by  the  indirect  method. 

5.  Selection  of  the  refractory  compound  and  the  imbedding 
of  the  wax  model  to  construct  the  mold. 

6.  Drying  out  of  the  mold,  and  the  burning  out  of  the  wax 
model. 

7.  Casting  of  the  molten  metal  into  the  mold. 

8.  Cleansing  of  the  casting  in  hydrofluoric  acid  and  in  a  so- 
dium bicarbonate  bath. 

9.  Removal   of  the   sprue,   forming   excess  gold,   and   the 
polishing  of  the  inlay. 

10.  Cementation  of  the  inlay. 

SUMMARY  FOR  CHAPTER  III 
The  Cast  Gold  Inlay 

1.  Classify  inlay  work. 

2.  What  metal  is  most  suitable  for  inlay  casting? 
:'*.   What  is  the  function  of  a  cast  gold  inlay? 

4.  What  :m>  the  steps  (in  thoir  proper  sequence)  that  arc  necessary  to 
produce  a  cast  gold  inlay. 


CHAPTER  IV 

SELECTION  OR  ELECTION  OF  THE  CASE 
PRESENTING  A  CAVITY 

(A)  Any  tooth  distally  to  the  clisto-proximal  surface  of  the 
canines,  requiring  a  gold  filling,  can  be  restored  more  perfectly 
by  means  of  a  cast  gold  inlay. 

(B)  Any  labio-  or  linguo-gingival  cavity  larger  in  diameter 
than  3  mm.  distally  to  the  second  bicuspid  calls  for  a  restora- 
tion by  means  of  an  inlay  rather  than  a  malleted  filling. 

(C)  Any  tooth  requiring  restoration  of  proximal  contact 
calls  for  an  inlay  rather  than  a  malleted  filling. 

(D)  Any  tooth  requiring  occlusal  restoration  in  its  relation 
to  opposing  teeth  calls  most  emphatically  for  a  cast  gold  inlay 
in  preference  to  a  malleted  gold  foil  filling. 

(E)  Any  compound  cavity  in  any  tooth,  distally  to  the  first 
bicuspid,  calling  for  a  gold  restoration,  indicates  the  use  of  an 
inlay  rather  than  a  malleted  filling. 

(F)  Every  mesio-disto-occlusal  cavity  in  any  multicuspid 
tooth,  should  be  filled  by  means  of  an  inlay  rather  than  a  mal- 
leted gold  foil  filling. 

The  gold  inlay  is  contraindicated  in : 

(a)  Small  proximal  cavities  in  the  anterior  teeth. 

(b)  Small  fissure  cavities  in  anterior  teeth  lingually  and, 

(c)  Small  cavities  in  posterior  teeth  occlusally, 

(d)  Small  labial  cavities  in  posterior  teeth  in  mouths  com- 
paratively immune  to  progress  of  decay. 

SUMMARY  TOR  CHAPTER  IV 
Selection  or  Election  of  the  Case  Presenting  a  Cavity. 

1.  Name  the  types  of  cavities  when  a  east  gold  inlay  is  indicated. 

2.  In  what  cases  is  the  inlay  contraindicated? 


61 


CIIAITKU  V 

CAVITY  J'UKI'ARATIOX 

GEOMETRIC    LANDMARKS    OF   TEETH 

Tooth  Surfaces  and  Angles 

Kvcry  incisor  tooth  presents  for  examination  four  distinct 
surfaces;  a  cutting,  or  incisal  edge,  and  a  nunil)er  of  line  and 
point  angles  as  follows:  (See  (.Fig.  2.) 

SURFACES  OF  INCISOR  TKKTII 
.Mesial  (1) 
Distal  (2) 
Labial  (3) 
Lingual  (4) 
A  distinct  incisal  surface  at  times  (5) 

ANGLES  or  INCISOR  TEETH 

Line  Angles 
Mesio-labial  (6) 
Mesio-lingual  (7) 
Disto-labial  (8) 
Disto-lingual  (9) 

Cutthif/,  or  Point,  Angles 
Mesio-labio-incisal  (10) 
Disto-labio-incisal  (11) 
Mesio-linguo-incisal  (12) 
Disto-linguo-incisal  (13) 

In  incisors  having  a  distinct  incisal  surface,  the  following 
line  angles  must  be  added. 

Line  Angles 
Labio-incisal  (14) 
Linguo-incisal  (15) 
Mesio-incisal  (16) 
Disto-incisal  (17) 

05 


66 


CAST  GOLD  AXD  PORCELAIN  IXLAYS 


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CAVITY    ntKPAKATIOX  67 

The  cuspids,  upper  and  lower,  present  for  examination  four, 
and  rarely  five,  distinct  surfaces,  a  tearing  point,  or  cusp,  which 
latter  is  sometimes  replaced  hy  a  cutting  edge  or  a  distinct 
incisal,  or,  better,  prehensile  sin-face.  (See  Fig.  l>.) 

SURFACES  OF  CUSPIDS 
Mesial  (1) 
Distal  (2) 
Lingual  (3) 
Labial  (4),  sometimes  broken 

by  the  labial  ridge  into 
Labio-mesial  and  (5), 
Labio-distal  surfaces  (6) 

AXGLES  OF  CUSPIDS 

Line  Angles 
Mesio-labial  (7) 
Mesio-lingual  (8) 
Disto-lingual  (9) 

Disto-labial  (10),  and  very  often  the  labial  angle  (11), 
formed  by  the  mesio-labial  and  disto-labial  surfaces,  and  when 
there  is  a  distinct  prehensile  surface,  there  are  the  line  angles 
of  the 

Labio-prehensile  (12) 
Linguo-prehensile  (13) 
Mesio-prehensile  (14) 
Disto-prehensile  (15) 

Line  Angles 

Mesio-labio-prehensile  (16) 
Mesio-linguo-prehensile  (17) 
Disto-labio-prehensile  (18) 
Disto-linguo-prehensile  (19), 

and,  at  the  cusp  extremity,  the 

Labio-linguo-prehensile  (20),  point  angle  formed  by  the 
labial,  the  lingual  surfaces,  and  the  prehensile  surface  of  the 
tooth.  And  when  the  labial  ridge  is  present  in  a  cuspid,  the  last 
named  point  angle  may  be  referred  to  as  the  antero-labio-incisal, 
or  prehensile  (21),  and  postero-labio-incisal,  or  prehensile,  angle 
of  the  cuspid  (22). 


68  CAST    (;<>!. I>    AND    POUCKLAIX     INLAYS 

With  the  appearance  of  a  distinct  incisal  or  prehensile  sur- 
faces circumscribing  the  prehensile  surface  for  its  entire  extent, 
the  prehensile  surface  assumes  the  shape  of  an  ellipse,  line 
angles  only,  present  themselves,  and  we  have  the  mesial  and 
distal  arcs  formed  by  the  mesial,  labial,  lingual,  and  distal  sur- 
faces circumscribing  the  prehensile  surface  for  its  entire  extent. 

The  bicuspids  and  molars  present  for  the  inlay  Avorker  live 
surfaces  as  follows:  (See  Fig.  4.) 

SURFACES  OF  BICUSPIDS 

Mesial  (1) 
Distal  (2) 
Buccal  (3) 
Lingual  (4) 
Occlusal  (5) 

The  occlusal  surfaces  of  the  bicuspids  and  molars  are  sub- 
divided into  twice  as  many  smaller  surfaces  as  the  cuspids  have 
ridges,  each  ridge  diA-.iding  the  surface  of  the  cusp  upon  which 
it  presents  itself  into  tAVO  surfaces;  the  number  of  line  angles 
and  point  angles  present  in  these  teeth  is,  therefore,  correspond- 
ingly increased. 

If  the  occlusal  surface  is  considered  as  an  interrupted  hor- 
izontal surface,  the  line  angles  in  the  bicuspids  and  molars  are, 
according  to  Black  (AV!IO,  by  the  way,  treats  this  surface  only 
as  such),  as  follows: 

ANGLES  OF  BICUSPIDS  AND  MOLARS 

Line  Angles 

Mesio-buccal  (6) 
Disto-buccal  (7) 
Mesio-lingual  (8) 
Disto-lingual  (9) 
Mesio-occlusal  (10) 
Disto-occlusal  (11) 
Bucco-occlusal  (12) 
Linguo-occlusal  (13) 


CAVITY    PRKL'AKA'liOX  6'{) 

Point  A  U 


Mesio-bucco-occlusal  (14) 
Disto-bucco-occlusal  (lf>) 
Mesio-linguo-occlusal  (  1  <>) 
Disto-lingno-occlusal  (17) 

Tt  might  he  well  to  remember  that  in  tliis  geometric  geogra- 
phy, we  a  iv  much  closer  to  spherical  than  just  plain  geometry, 
and  so  the  reference  to  each  surface  as  distinct  by,  and  for,  it- 
self, and  the  corresponding  angle  (surface  angles)  need  not  be 
dwelt  upon. 

It  is  best  to  consider  the  surfaces  of  these  teeth  as  merging 
into  one  another  presenting  no  harsh  or  sharp  deviations  which 
are  always  weak  points  both  in  beauty  and  construction. 

The  exception  to  this  foregoing-,  is  the  occlusal  surface  of 
the  posterior  teeth.  Here  the  division  of  this  surface  by  the 
various  ridges  presenting  themselves  upon  their  respective 
cusps  must  be  distinct  and  well  defined,  producing  eminences, 
sulci,  and  fossa'  in  contradistinction  to  the  undulations  present 
upon  the  other  surfaces  of  these  teeth. 

HYGIENIC  LANDMARKS  OF  THE  TEETH 

The  inlay  worker  must  consider  two  distinct  areas  in  each 
tooth  : 

First:    The  immune,  or  comparatively  immune,  area. 

Second:    Susceptible  area. 

The  immune  area  of  a  tooth  is  that  part  of  it  which  is 
constantly  being  cleaned  and  kept  free  from  debris  by  incision, 
prehension,  mastication,  and  trituration,  or  by  the  action  of 
lips,  cheeks,  tongue  and  toothbrush. 

The  susceptible  areas  are  the  portions  of  the  teeth  not  so 
cleaned;  in  other  words,  the  portions  inaccessible  to  cleansing 
friction  by  the  agents  named. 

Among  the  former,  or  comparatively  immune  areas,  may  be 
mentioned  the  labial,  lingual,  and  incisal  surfaces  of  the  an- 
terior teeth;  the  buccal,  lingual,  and  the  welling  portions  of  the 
occlusal  surfaces  of  the  posterior  teeth;  and,  in  mouths  free  from 
pathologically  invaded  alveoli,  the  gingival  and  subgingival  cir- 
cumference. 


70 


CAST  GOLD  AND  PORCELAIN  INLAYS 


To  tlie  susceptible  areas  belong  the  proximal  surfaces  of  the 
teeth,  the  distal  surfaces  of  the  last  molars,  and  the  gingival 
third  of  the  buccal  surfaces  of  the  last  molars;  the  deep  sulci, 
fossae,  and  fissures  upon  the  occlusal  surfaces  of  the  posterior 
teeth;  the  deep  fissures  on  the  lingual  surfaces  of  anterior 
teeth;  and,  in  cases  subject  to  pathologic  invasion  of  the  alveoli, 
and  the  consequent  breaking  of  the  last  named  structure,  all 
gingival  and  subgingival  surfaces  open  to  contact  with  fer- 
mentation and  not  easily  dislodged  food  debris.  (Figs.  5,  6, 
and  7.) 


Fig.   6. 


Fig.    7. 


Fig.  5. — Showing  immune  areas  of  anterior  teetli  and  susceptible  areas.  Im- 
mune areas:  1,  labial  surface;  2,  lingual  surface;  3,  incisal  surface.  Susceptible 
areas:  4,  disto-proximal  surface;  5,  mesio-proximal  surface;  6,  cervical  portion  of 
labial  surface. 

Fig.  6. — Immune  areas  of  posterior  teetli.  1,  2,  3,  4,  welling  portions  of  occlusal 
surface;  5,  buccal  surface;  6,  lingual  surface. 

Fig.  7. — Immune  areas  and  susceptible  areas  of  posterior  teeth.  Immune 
areas:  1,  buccal  surface;  2,  lingual  surface;  3,  4,  5,  6,  welling  portions  of  occlusal 
surfaces.  Susceptible  areas:  1,  mesio-proximal  surface;  8,  disto-proximal  sur- 
face; 9,  10,  11,  sulci  and  fissures  of  occlusal  surfaces.  12  and  13,  bucco-  and  linguo- 
gingival  areas;  sometimes  susceptible,  often  immune. 


CAVITY    PKKPAKATIOX  71 

Three  great  factors  enter  into  actual  cavity  preparation. 
They  are: 

1.  The  surgical  or  operative,  which  means  the  actual  cutting 
of  tooth  structure  (including  the  extirpation  of  the  pulp,  the 
proper  treatment  and  filling  of  the  root  canals). 

2.  The  mechanical,  or  formative,  which  means  that  mode 
of  tooth  structure  cutting  which  brings  it,  when  cut,  into  the 
field  of  physics,  geometry,  and  mathematics. 

3.  The  alterative  factor,  which  means  the  factor  tending  to 
produce  a  change  from  a  decrepit  or  abnormal  to  a  healthy  con- 
dition because  of  its  restoration  to  proper  physical  relation  to 
the  surrounding  tissues. 

A  cavity  prepared  for  the  reception  of  a  cast  gold  inlay, 
must  comply  with  the  following  requirements: 

1.  It  must  offer  a  series  of  angles  and  surfaces  best  suited 
to  resist  stress  or  tendency  to  fracture  the  tooth. 

2.  It  must  present  margins  so  prepared  as  to  conserve  the 
enamel  structure  of  the  tooth  and  not  expose  it  to  injury  dur- 
ing stress  of  occlusion  and  mastication. 

3.  It  must  offer  a  ready  access  for  the  making  of  the  wax 
model  in  the  direct  method  or  for  the  taking  of  an  impression 
of  the  cavity  in  the  indirect  method. 

4.  It  must  offer  a  retentive  receptacle  and  support  to  the 
inlay. 

5.  It  must  offer  a  series  of  angles  and  surfaces  best  suited 
to  resist  the  stress  of  tendency  to  dislodge  the  inlay. 

6.  It  must  present  margins  so  prepared  that  the  finished 
operation  will  conform  as  nearly  as  possible  to  the  highest  con- 
ception of  beauty  of  form. 

7.  It  must  present  a  form  for  the  reception  of  the  inlay 
which  shall  bring  the  various  margins  into  areas  of  compara- 
tive immunities.     This  last  requirement  is  what  is  commonly 
understood  as  extension  for  prevention,  and  the  necessity  for 
it  varies  with  the  condition,  habits,  and  understanding  of  the 
patient,  and  to  a  limited  extent  must  be  left  to  the  judgment 
of  tlie  operator. 

Root  canal  treatment  does  not  come  within  the  scope  of 
this  volume,  and,  since  the  canals  of  the  teeth  we  are  called  upon 
to  restore  or  rebuild  by  means  of  inlays,  play  a  very  important 


{'2  CAST  GOLD  AX1)  TORCELAIX  INLAYS 

part  ill  the  preparation  of  the  cavity,  the  reader  will  please 
bear  in  mind  that  I  speak  of  canals  properly  treated  and  filled 
as  we  understand  this  work  today.  For  comprehensive,  though 
by  no  means  final,  information  on  the  subject,  the  student  is 
referred  to  the  writing's  of  such  men  as  Rhein,  Callahan,  Otto- 
lengui,  etc.,  whose  splendid  and  careful  work  in  this  field,  has 
been  of  inestimable  aid  to  the  profession. 

It  is  further  assumed  that  the  student  has  enjoyed  the  ad- 
vantage of  a  course  in  the  microscopic  study  of  the  structure 
of  the  tooth;  that  he  understands  the  histology,  and  is  familiar 


Fig.  8. — A  set  of  chisels  used  by  the  author  in  tooth  structure  cutting. 

with  the  manner  in  which  the  enamel  rods  are  disposed  over  the 
crown  surfaces  of  the  teeth,  and  the  consideration  he  is  to  give' 
this  factor,  when  cavity  preparation  is  attempted. 

For  the  uninitiated,  this  will  make  a  serious  break  in  the 
sequence  of  this  volume,  but  they,  in  fact,  should  not  read  this 
at  all.  The  two  mentioned  departments  of  root  work  and  his- 
tology are  part  of  the  embryo  of  knowledge  which  he  who  would 
practice  inlay  work,  must  possess  himself  of. 

Piersol,  Schafer,  or  Noyes,  on  the  histology  of  the  teeth, 


PltKPAIIATlOX  (.'5 

will  give  the  student   a  mass  of  very  necessary  and  very   per- 
tinent information. 

Among  the  instruments  of  the  inlay  worker  must  be  in- 
cluded: Comprehensive  set  of  chisels, — straight,  right  and  left, 
at  varying  obtuse  angles,  to  facilitate  cutting  of  gingival  areas; 
pear-shape;!  and  inverted  cone  burrs;  and  various  file-cut  inlay 
burrs  for  straight  handpiece  and  centra-angle;  mandrils  for 
carrying  sandpaper  discs  and  carborundum  discs  for  both;  and 
most  important,  a  set  of  small  gem  stones  mounted  upon  man- 
drils for  both  handpit  ees,  and  a  variety  of  shapes  to  fill  every 
possible  requirement. 

Fissure  burrs,  cross-cut  or  plain,  plug-shaped  and  tapered, 
may  be  added  to  complete  the  surgical  and  mechanical  abrasive 
instrument  list  for  cavity  preparation. 

The  nect  ssity  for  the  rubber  <iam  and  clamp  is  manifest 
when  the  saliva  interferes  with  clean,  rapid  work. 

The  general  rules  for  tooth  cutting  may  be  enumerated  as 
follows: 

All  overhanging  enamel  walls  must  be  removed  with  the 
properly  inclined  chisels,  driven  by  direct  hand  pressure  or  a 
leather  covered  metallic  mallet. 

The  opening  of  cavities  must  be  started  with  sharp  burrs, 
plug-shaped  or  cross-cut  tapered  fissure  burrs  of  the  smallest 
size  suitable. 

As  soon  as  the  cavity  is  large  enough  to  permit  the  using 
of  a  gem  stone,  the  use  of  steel  burrs  must  be  discontinued  and 
the  stones  substituted. 

At  no  time  of  the  operation  shall  the  tooth  be  allowed  to 
heat  up,  and  with  this  end  in  view,  all  stones  used  in  cavity 
cutting  are  run  under  water. 

The  margins  are  chiseled  and  then  finished  with  sandpaper 
and  cuttlefish  discs. 

A  cavity  in  a  tooth  can  not  be  properly  prepared  unless 
that  tooth  and  the  teeth  adjoining  it,  if  there  be  any,  have  been 
thoroughly  cleansed  of  any  deposits  which  may  be  present;  and 
if  the  cavity  extends  beneath  the  border  of  the  gingival  line,  un- 
it ss  the  gum  has  been  carefully  but  effectually  displaced  from 
the  field  of  operation. 

Scah-r>    for  the   removal   of   deposits   and    porte-polishers. 


74 


CAST    COLD    AND    POIU'KLAIX    INLAYS 


carrying  finely  powdered  pumice  stone  or  silex,  will  accomplish 
the  first  part  of  the  operation;  while  the  displacement  of  gum 
tissue  is  readily  brought  about  by  packing  the  cavity  with  soft- 
ened gutta-percha  base  plate,  and  leaving  that  in  the  cavity  for 
a  few  days.  The  case  presenting  itself  again,  the  base  plate  is 
softened  by  means  of  warm  instruments  and  removed. 

A  comprehensive  view  of  the  field  of  operation  will  aid  us 
in  determining  just  what  instruments  we  shall  have  to  employ 
in  the  actual  preparation  of  the  cavity  we  are  about  to  begin. 

The  inlay  worker  recognizes  three  distinct  types  of  cavities; 
they  are,  the  simple,  the  compound,  and  the 


Fie.  9. 


Fig.  10. 


Fig.  9. — Cross  section  of  molar  tooth  illustrating  prepared  cavity  and  bevel. 
1,  2,  3,  cavity  and  bevel;  4,  5,  6,  arms  and  body  of  pulp.  Simple  cavity. 

Fig.  10. — Cross  section  of  molar  showing  a  disto-occlusal  cavity.  1,  bevel 
upon  occlusal  surface;  2,  inclined  plane  offering  powerful  resistance  to  displace- 
ment; 3,  flat  portion  of  gingival  seat;  4,  beveled  portion  of  gingival  seat.  Com- 
pound cavity. 

A  simple  cavity  is  one  which  involves  but  one  surface  of  a 
tooth. 

There  are  the  simple-labial,  the  simple-lingual,  and  simple- 
occlusal,  or  incisal,  cavities. 

A  compound  cavity  is  one  which  involves  more  than  one, 
and  may  involve  all  but  one,  surface  of  the  tooth. 


CAVITY    PHKPAKAT10X  75 

There  are  as  examples  of  compound  cavities: 

1.  The  mesio-occlusal 

2.  The  disto-occlusal 

o.  The  mesio-labio-occlusal 

4.  The  disto-labio-occlusal 

5.  The  mesio-labial 

6.  The  mesio-lingual 

7.  Tlie  disto-labial 

8.  The  disto-lingual 

9.  The  labio-occlusal 

10.  Tlie  linguo-occlusal 

11.  The  labio-occluso-lingual 

12.  The  inesJo-occluso-distal,   or  what 

is  known  as  the  M.  0.  I),  cavity. 

A  complex  cavity  is  one  that  takes  up  at  least  a  part  of 
every  surface  of  a  tooth,  and  as  an  example  may  be  mentioned, 

A  mesio-labio-linguo-occluso-distal  cavity. 

The  surgical  work  in  the  preparation  of  simple  cavities  con- 
sists, outside  of  root  treatment  and  elimination  of  impeding 
gum  tissue,  merely  in  the  laying  open  of  the  cavity  area  and  the 
chiseling  of  the  surrounding  walls. 

The  mechanical  or  formative  part  of  the  work  consists  in 
stoning  the  walls  and  floor  of  the  cavity  in  such  a  manner  that 
it  will  conform  in  curvature  to  the  curve  of  the  surface  upon 
which  it  is  present. 

The  surrounding  walls  may  be  stoned  so  that  for  two-thirds 
of  their  depth  they  shall  be  perpendicular  to  the  cavo  surface, 
and  the  remaining  third  of  the  surrounding  walls  nearest  the  or- 
ifice of  the  cavity  may  deviate  from  the  perpendicular  and  di- 
verge to  form  an  angle  of  30  to  45  degrees. 

The  alterative  part  of  the  work  consists  in  so  completing 
the  preparation  that  it  will  present  a  sightly  and  pleasing  ami 
lasting  result,  properly  protecting  the  enamel,  that  it  will  bring 
all  the  margins  into  areas  of  comparative  immunity,  and  thus 
present  a  restoration  most  acceptable  to  the  surrounding  tis- 
sues, and  hence  conducive  to  the  utmost  conservation  of  the 
tooth. 

In  compound  and  complex  cavities,  the  alterative  part  of 
the  preparation  concerns  itself  with  the  proper  amount  of  sepa- 


76  CAST    CIO  LI.)    AND    rORCKLAlN     INLAYS 

ration  required  (when  any  is  required),  and  with  the  restoration 
of  what  may  be  called  the  occlusal  balance. 

We  must  bear  in  mind  that  the  occlusal  surface  of  the  pos- 
terior teeth  serves,  not  only  in  the  function  of  mastication  and 
trituration,  but  by  virtue  of  its  peculiar  formation  at  the  mesio- 
and  disto-occlusal  lines,  respectively,  prevents  the  crowding  of 
the  food  into  the  interdental  spaces  with  an  efficiency  in  propor- 
tion to  the  correct  formation  of  the  points  indicated.  In  other 
words,  the  occlusal  surfaces  of  these  teeth  has  more  than  one 
function;  that  of  mastication  and  trituration  of  food,  and  that 
of  the  prevention  of  the  crowding  of  food  into  the  interdental 
spaces. 

A  great  many  cases  of  so-called  pyorrhea  and  other  gin- 
gival  lesions,  may  be  traced  directly  to  poorly  executed  occlu- 
sal restoration;  and  when  we  realize  this,  we  shall  conclude  that 
these  surfaces  must  be  treated  with  as  great,  if  not  greater,  care 
than  any  other  tooth  surface  in  the  oral  cavity. 

A  poorly  restored  occlusal  surface  may  throw  the  entire 
face  out  of  balance,  and  so  become  the  cause  of  a  case  of  mal- 
occlusion,  which  may  entail  months  or  years  of  unremitting 
effort  to  correct. 

This  brings  us  face  to  face  with  the  realization  that  only 
by  means  of  the  cast  inlay  is  a  perfect  occlusal  restoration  pos- 
sible. 

CAVITY  PREPARATION 

The  surgical  work  in  the  preparation  of  the  compound  and 
complex  cavities,  consists  in  the  cleansing  of  the  field  of  opera- 
tion, and  its  surroundings,  of  the  chiseling  away  of  the  over- 
hanging walls  in  such  a  manner  that  no  unsupported  enamel 
walls  be  left  standing. 

The  margins  are  so  prepared  that  no  short  enamel  rods 
present  any  feather  edge  for  the  inlay  to  frictionally  play 
against.  If  the  margin  of  destruction  terminates  in  a  deep  sul- 
cus  of  the  occlusal  surface  of  a  tooth,  then  the  cavity  must  be 
extended  so  that  the  margins  of  it,  at  that  point,  are  carried 
into,  and  beyond  the  sulcus  onto  the  ascending  portion  of  the 


CAVITY     IMIKPAIIATIOX  ,  r 

cusp.  The  suk'iis  is  then  reproduced  in  the  wax  inlay,  to  be 
subsequently  duplicated  in  the  gold. 

The  enamel  seat  of  the  inlay  should  be  as  broad  and  ex- 
tensive as  possible,  and  with  that  end  in  view,  the  bevel  butt 
joint  is  used. 

In  teeth  presenting  a  live  pulp,  the  location  of  this  organ 
must  more  or  less  determine  the  extent  of  botli  surgical  and 
mechanical  or  formative  work  to  be  done  on  and  in  the  cavity. 

When  no  pulps  are  present,  the  pulp  canals  and  chamber 
must  come  in  for  their  share  of  the  surgical  attention,  in  that 
the  former  are  properly  tilled,  and  the  coronal  part  so  cut  as 
to  form  flat  and  variously  slanting  substantial  seats  for  the  inlay. 

It  is  the  mechanical,  or  formative,  part  of  the  work  that 
comes  in  for  very  careful  attention  and  for  considerable  study. 
The  direction  of  the  stress,  which  the  particular  tooth  is  called 
upon  to  withstand,  should  largely  determine  the  form  of  cavity 
which  we  shall  prepare  for  an  inlay.  As  a  broad  and  general 
rule,  the  following  may  be  considered: 

The  frictional  or  contact  relation  which  exists  between  a 
tooth  and  the  inlay  made  for  it,  should  be,  at  least  half  again 
as  large  as  that  part  of  the  inlay  which  will  be  called  upon  to 
enter  into  stress  relation  with  the  opposing  teeth  and  surround- 
ing tissues. 

This  applies  to  all  cavities  and  most  particularly  to  com- 
pound and  complex  cavities,  and  in  these  latter  cavities,  the 
rule  may  be  elucidated  as  follows:  the  more  of  an  inlay  inside 
the  tooth,  and  the  less  of  an  inlay  outside  the  tooth,  the  less 
chance  for  surgical  or  mechanical  injury  to  that  tooth. 

Please  note  the  hixidc  of  the  tooth  and  outbid?  of  the  tooth, 
and  do  not  confuse  with  mi  or  above  the  tooth.  An  inlay  may 
be  made  for  a  tooth,  'and  it  may  present  or  restore  the  entire 
occlusal  surface  of  that  tooth,  and  so  expose  a  very  extensive 
area  to  stress  relation  with  the  opposing  teeth,  and  the  area 
of  frictional  relation  between  this  cavity  and  this  inlay  may 
>eem  to  be  smaller  in  extent  than  the  area  exposed  to  stress. 
These  inlays  must  be  considered  as  resting  in  a  box  seat;  in 
other  words,  the  cavity  is  one  presenting  the  appearance  of  a 
simple  one  in  every  surface  but  the  floor;  here  is  found  a  devia- 
tion in  that  floor,  instead  of  conforming  in  shape  to  the  sur- 


78 


CAST  GOLD  AND  PORCELAIN  INLAYS 


face  upon  which  it  presents,  slopes  to  become  an  inclined  plane 
to  offer  the  required  resistance  to  displacement  during-  stress 
of  mastication.  The  incline  should  be  sharp  and  well  defined; 
a  step  may  be  used,  but  an  incline  tends  to  better  conservation 
of  the  tooth. 

In  teeth  subject  to  stress,  from  and  in  more  than  one  di- 
rection, these  lines  of  stress  must  be  carefully  studied,  and  an 
inclined  plane  must  be  formed  upon  the  floor  of  the  cavity  to 
oppose  each  line  of  direction  of  stress. 

In  cases  where  the  cusps  are  very  deep,  and  where  the  man- 
dible enjoys  a  limited  laterorotary  motion,  thus  subjecting  the 
molar  teeth  to  a  considerably  greater  amount  of  laterorotary 
stress  than  would  be  the  case  if  the  motion  of  the  mandible  were 


Fig.  11. 


Fig.  12. 


Fig.  11. — Longitudinal  section  of  molar,  at  1  and  2,  mesial  and  distal  planes, 
respectively,  with  apex  at  3.  Note  correspondence  of  incline  in  planes  and 
bevels  at  4  and  5.  Planes  and  bevels  are  practicall  parallel.  Complex  cavity. 

Fig.  12. — Cross  section  of  bicuspid  showing  (1)  occluso-disto-lingual  plane 
and  (2)  occluso-mesio-buccal  plane.  Complex  cavity. 

very  free  in  that  direction,  the  floor  of  these  cavities  should  pre- 
sent four  distinct  planes,  and,  for  convenience,  may  be  desig- 
nated as:  the  mesial  plane;  the  distal  plane;  the  lingual  or 
palatal  plane;  and  the  buccal  plane.  The  highest  point  of  the 
floor  of  the  cavity  may  be  called  the  apex;  and  these  planes  will 
correspond,  or  should,  as  nearly  as  possible,  correspond,  in  pitch 
or  angles  to  the  plane  presenting  as  a  bevel  upon  surface  of 
the  cavity,  to-wit:  mesio-occlusal;  disto-occlusal;  bucco-occlusal ; 
linguo-occlusal.  Thus  if  the  extent  of  the  area  of  the  inlay  in 


CAVITY    HIKPAItATIOX  79 

f  rirtional  relation  with  the  cavity  of  the  tootli  he  carefully  ex- 
amined, it  will  |)o  found  to  exceed  the  area  of  the  inlay  in  stiv>- 
relation  with  the  opposing  teeth  and  surrounding  tissues. 

In  molar  teeth  and  bicuspids,  which  are  unusually  small, 
and  in  which  restorations  of  this  character  are  necessary,  the 
preparation  of  these  planes  may  be  so  varied  that  only  two 
instead  of  four  planes  are  made,  and  in  these  cases,  the  high- 
est part  of  the  iloor  shall  be  a  diagonal  line  from  the  disto-buccal 
to  mesio-lingual,  or  the  disto-lingual  to  the  mesio-buecal  angle 
of  the  tooth,  respectively;  there  will  be  the 

Occluso-disto-lingual  plane,  and  the 
Occluso-mesio-buccal  plane. 

With  a  view  to  greater  resistance  to  fracture  of  the  tooth, 
and  to  displacement  of  the  inlay,  planes  are  by  far  to  be  pre- 
ferred to  supplemental  pins,  except  when  these  pins  can  be 
placed  into  the  pulp  chamber,  or  canals,  and  even  then,  a  multi- 
plicity of  these  supplemental  pins  would  needlessly  complicate 
the  preparation,  in  that  the  holes  to  receive  them  would  neces- 
sarily have  to  be  parallel  to  all  vertical  walls  of  the  cavity  and 
to  each  other. 

In  vital  teeth  these  pins  should  be  looked  upon  as  a  means 
of  last  resource,  and,  when  used  at  all,  they  should  be  as  stout 
as  the  bulk  of  the  tootli  structures  in  that  locality  will  allow; 
they  should  enter  the  tooth  structure  to  a  depth  equal  to  at  least 
half  of  their  circumference  and  no  greater  than  their  circum- 
ference. 

For  molar  teeth  a  15-  or  16-gauge  iridio-platinum  wire  is 
used  and  for  bicuspids  a  17-  or  18-  or  even  20-gauge  wire  will 
suffice. 

There  should  be  at  least  15  per  cent  iridium  in  the  platinum, 
and  it  may  be  threaded  in  two  or  three  inch  lengths  and  cut  into 
small  pieces  equal  in  length  to  the  circumference  of  the  wire. 

These  pieces  are  coated  to  half  their  length  with  graphite 
or  whiting,  and  a  small  piece  of  pure  gold  is  wrapped  around 
the  other  half  and  joined  to  it  with  the  blowpipe.  This  pre- 
caution will  insure  the  picking  of  these  wires  when  the  inlay 
is  cast,  and  will  also  insure  a  perfect  union  between  the  gold 
of  the  inlay  and  these  wires. 


so 


CAST    <!<>Li>    AND    POIICKLAIX    INLAYS 


Fig.  14. 


Fiff.  15. 


l-'i-T.  ]<) 


iff.  1". 


CAVITY     IMtKI'AKATloX  81 


FIVK    VIKWS    OK   AX    UPPER    FIRST   BICUSPID   PRESENTING   A 
Orrr.rsAL  CAVITY,  AND  THE  CAST  GOLD  INLAY  MADE  FOR  IT. 

Fig.  13. — A  view  of  the  cavity.  Note  the  depth  and  the  bevel 
on  the  occlusal  third  of  the  depth.  „ 

Fig.  14. — Occlusal  view  of  the  carved  inlay.  Note  the  trans- 
verse groove  and  the  marginal  ridges. 

Fiy;.  lo. — A  cavo-surt'ace  view  of  the  inlay.  Note  the  well- 
ilelined  outlines  and  the  bevel. 

Figs.  16  and  17. — Views  of  the  finished  operation.  Note  the 
extension  of  the  margins  to  the  ascending  portions  of  the  cusps 
siiid  marginal  ridges. 

Stress  Index:     Upward,  out  and  backward,  in  and  forward  or 

intriHllrcohir,    LABIO-DlSTALLY    and    LlNGUO-MESTALLY. 


82 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Fig.  18. 


Fig.  19. 


Fig.  20. 


Fig.  21. 


Fig.  22. 


Fig.  23. 


Fig.  24. 


CAVITY    PREPARATION"  83 


SEVEN  VIEWS  OF  A  FIRST  EIGHT  LOWER  BICUSPID  PRESENT- 
ING A  COMPOUND  DISTO-OCCLUSAL  CAVITY  INVOLVING  ALSO  THE 
CERVICAL  PORTION  OF  THE  BUCCAL  WALL,  RESTORED  WITH  A  CAST 
GOLD  INLAY  DISTO-OCCLUSALLY,  AND  A  PORCELAIN  INLAY  Buc- 

CAI.LY. 

Fig.  18. — A  view  of  the  cavity.  Note  the  well-defined  step 
with  its  inclined  plane  running  mesially,  the  well-defined  gingival 
scat  with  its  bevel,  the  broad,  well-beveled  enamel  margins  ling- 
ually,  buccally,  and  occlusally. 

Fig.  19. — A  view  of  the  cervical  cavity  prepared  for  the  por- 
celain inlay.  Note  the  bevel  of  the  external  third  of  the  cavity 
walls  and  note  how  the  floor  of  the  cavity  conforms  to  the  wall 
of  the  tooth  upon  which  it  presents. 

Fig.  20. — An  occlusal  view  of  the  disto-occlusal  cavity.  Note 
the  bevel  of  the  margins  here, — how  they  have  been  carried  to  the 
immune  areas. 

Figs.  21  and  22. — Views  of  the  inlay.  Note  in  Fig.  19  the 
carving  upon  the  occlusal  surface,  and  in  Fig  20,  the  well-balanced 
retentive  form  and  seat  of  the  inlay. 

Fig.  23. — A  view  of  the  finished  inlays  in  position.  Note  the 
operation  carried  into  the  area  of  immunity  buccally. 

Fig.  24. — A  disto-bucco-linguo-occlusal  view  of  the  finished 
operation.  Note  here  the  lingual  part  of  the  operation  carried 
into  the  area  of  comparative  immunity. 

The  gold  inlay  for  the  restoration  of  the  disto-occlusal  part 
of  the  tooth  is  completed  and  forms  the  disto-buccal  angle  of 
the  cavity  for  the  porcelain  inlay. 

Stress  Index:  Down  and  inward,  down  and  backward  and 
down  and  forward  or  INTRALINGUALLY,*  intradistally*  and  intra- 
mesially.* 


"Intraalvoolar. 


CAST    COLD    AND    POIiCKLA  I  X     IX  LAVS 


Fig.  25. 


Fio-.  2(5. 


Fig.  27, 


Fig.  28. 


Fig.  29. 


Fig.  30. 


Fig.  31. 


Fig.  32 


CAVITY    I'KKI'AKATION 


EIGHT  VIEWS  OK  AX  UPPER  FIRST  BICUSPID  PRESENTING  A 
AlKSIO-OCCLUSAL  CAVITY,  AXI)  THE  RESTORATION  MADE  FOR  IT. 

Fig>.  -~>,  -('),  and  27. — Different  views  of  the  cavity.  They 
explain  themselves. 

Fi-s.   28  and  2!>. —  Views  of  the  gold  inlay. 

Figs.  30,  31,  and  32. — Showing  the  finished  operation,  and 
how  the  mesial  portion  of  the  gold  inlay  may  be  replaced  with 
porcelain. 

Stress  Index :  Upward,  out  and  backward  and  in  and  for- 
ward or  IXTRAALVEOLAR,  labio-ilistally  and  linguo-mcsially. 


86 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Fig.  33. 


Fig.  34. 


Fig.  35. 


Fig.  36. 


Fig.  37. 


CAVITY    PREPARATION  87 


FIVE  VIEWS  OF  A  LOWER  SECOND  BICUSPID  PRESENTING  A 
MESIO-DlSTO-OCCLUSAL  CAVITY,  AND  THE  INLAY  MADE  FOR  IT. 

Fig.  33. — A  view  of  the  cavity.  Note  its  well-defined  step, 
the  beveled  gingival  seat,  the  beveled  enamel  margins.  Note  the 
whole  operation  carried  into  areas  of  comparative  immunity.  Note 
the  incline  of  the  occlusal  surface  of  the  cavity  so  that  it  forms 
an  acute  angle  with  the  distal  wall. 

Figs'.  34  and   35. — Occlusal  and  mesial  views  of  the  cavity. 

Figs.  36  and  37. — Views  of  the  inlay.  Note  in  Fig.  36  the 
definition  of  every  part  of  the  inlay,  and  in  Fig.  37,  the  occlusal 
restoration  anatomically  correct.  Note  the  lingual  cusps  and  the 
well-defined  marginal  ridges. 

Stress  Index:  Down  and  inward,  down  and  backward,  down 
and  forward,  or  INTRAIJNGUALLY,  intradistally  and  intramesially. 


88 


CAST    GOLD   AND    PORCELAIN    INLAYS 


Fig.  38. 


Fig.  39. 


Fig.  40. 


Fig.  41. 


Fig.  42. 


Fig.  43. 


Fig.  44. 


Fig.  45. 


Fig.  4G. 


CAVITY    PIIKI'AIIATIOX  S!) 


NINE  VIKWS  OK  A  MEsio-Occ'LrsAi.  CAVITY  i\  A  FIRST  Lo \VKII 
,  AND  RESTORATION  MADE  FOR  IT. 

A   CAST   COLD   INI.AV,  THE   MKSIO  LIXCU-AL  PART  OF  IT,  ix 

Tl'KX.     INLAYED    AVITJI     SYNTHETIC    PORCELAIN. 

Figs.  38,  39,  and  40.— Views  of  the  cavity.  Note  the  bevel- 
ing of  the  walls,  margins,  scat,  etc.  Note  the  acute  angle  formed 
by  the  ocdusal  and  mesial  surfaces  of  the  cavity. 

Fig.  41. — A  mesio-occlusal   view  of  inlay. 

Fig.  42. — A  cavo-surface  view  of  inlay. 

Figs.  4:i  and  44. — Occlusal  views  of  finished  operation.  Note 
how  the  margins  of  the  inlay  are  carried  to  the  ascending  portions 
of  cusp  and  sulci  of  the  tooth. 

Figs.  45  and  46. — Mesio-lingual  and  mesio-buccal  views  of 
the  finished  operation  carried  into  areas  of  comparative  immunity. 
Note  in  Fig.  46  the  outline  of  the  porcelain  insert. 

Stress  Index:  Down  and  inward,  down  and  backward,  down 
and  forward,  or  iNTKALiNGUALLY,  intradistally  and  intramesialty. 


90 


CAST    GOLD   A^TD    PORCELAISf    IXLAYS 


Fig.  47. 


Fig.  48. 


Fig.  49. 


Fig.  50. 


Fig.  51. 


Fig.  52. 


Fig.  53. 


Fig.  54. 


CAVITY    PREPARATION  91 


EIGHT  VIEWS  OF  A  LOWER  SECOND  BICUSPID  PRESENTING  A 
MESIO-DISTO-OCCLVSAL  CAVITY,  AND  THE  RESTORATION  MADE  FOR 
IT. 

A  CAST  GOLD  INLAY,  THE  MESIO-BUCCAL  AND  DISTO-BUCCAL 
PARTS  OF  IT,  IN  TURN,  INLAYED  WITH  SYNTHETIC  PORCELAIN. 

Figs-  47,  48,  and  49. — Views  of  Cavity  showing  bevels,  seats, 
and  taper,  also  occluso-disto-lingual  piano  and  occluso-mesio-buc- 
cal  plane. 

Fig.  50. — Occlusal  view  of  inlay. 

Fig.  51. — Cavo-surface  view  of  inlay.  Note  reproduction  of 
planes. 

Fig.  52. — Occlusal  view  of  inlay  in  position.  Note  the  carry- 
ing of  the  margins  of  the  inlay  to  the  ascending  portions  of  the 
cusps  and  sulci.  Note  reproduction  of  marginal  ridges. 

Figs  53  and  54. — Views  of  inlay  with  synthetic  insert  in 
position  on  the  tooth.  Note  the  carrying  of  the  restoration  into 
areas  of  comparative  immunity. 

Stress  Index:  Down  and  inward,  down  and  backward,  down 
and  forward  or  INTRALINGUALLY,  intradistally  and  intramesially. 


92 


CAST    GOLD    AND    POUCKLAI  X    INLAYS 


Fig.  55. 


Fig.  56. 


Fig.  57. 


Fig.  59. 


Fig.  60. 


A    FIKST  LowF.it  MOLAR  PRKSKXTIXI;  A  LABIO-  OR  Bucco-Oc- 
CAVITY,  AND  THK  CAST  GOLD  IXI.AY   MADE  FOR  IT. 


Fig  5o.  —  View  of  the  prepaid!  cavity.  Note  bevel  upon  oc- 
dusal  surface  carried  to  the  ascending  portions  of  all  cusps.  Note 
acute  anglo  formed  by  the  floor  and  buccal  wall  of  the  cavity. 

Fig.  56.  —  A  clearer  view  of  the  buccal  surface  and  the  taper 
and  bevel. 

Fig.  57.  —  A  view  of  the  carved  inlay. 

Fig.   08.  —  A   cavo-surface   view   of  the  inlay. 

Figs.  o9  and  60.  —  View  of  the  finished  operation. 

Stress  Index:  Downward,  '  down  and  outward,  down  in  and 
forward,  down,  back  and  inward,  down,  fore  and  outward  or 
IxTRAAi.VF.or.AK,  i  nt  fdbiicco  -(I  ixtiil1  >i,  intrdluifiuo  *nix\uU)i.  intra- 
ly  and  intramesio-buccally. 


94 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Fig.  61. 


Fig.  62. 


Fig.  63. 


Fig.  64. 


Fig.  65. 


Fig.  66. 


Fig.  67. 


Fig.  68. 


CAVITY    PRKPAUATIOX  95 


A  LOWER  MOLAR  PRESENTING  A  DISTO-OCCLUSAL  CAVITY,  THE 
LOWER  HALF  OP  THE  BUCCAL  WALL  BEING  INVOLVED  TO  THE  FULL 
MESIO-DISTAL  EXTENT. 

Figs.  61,  62,  and  63. — Views  of  the  cavity. 

Figs.  64  and  (55. — Views  of  the  disto-ocelusal  inlay  made  for 
the  cavity. 

Figs.  (!6,  '57,  and  68.— Showing  the  finished  operation,  the 
bm-cal  surface  having  been  restored  with  a  porcelain  insert. 

The  disto-ocelusal  restoration  was  first  made  and  cemented, 
thus  leaving  a  simple  cavity  on  the  buccal  surface. 

Stress  Index:  Downward,  down  and  outward,  down  in  and 
forward,  down,  back  and  inward,  down,  fore  and  outward  or  IN- 
TRAAI.VEOLAK,  i iitrdbiicco-dist ally,  intralinguo-mcsially,  intradisto- 
lingualiy  and  intramesio-buccally. 


CAST    COM)    AND    POKCKLAI N    INLAYS 


Fig.  69. 


Fig.  70. 


Fig.  71. 


Fig.  72. 


Fig.  74. 


Fig.  75. 


Fiff.  78. 


CAVITY    PREPARATION  1)7 


A   DlSTO-OCCLUSAL  CAVITY   IX    AX   UPPER  MOLAR  AND  A  DlSTO- 

B  rev  A  i,  CAVITY  ix  TIIK  SAME  TOOTH. 

Two  CAST  GOLD  IM,\\S  FOR  THE  RESPECTIVE  CAVITIES  AND 
THREE  VIEWS  OF  THE  FINISHED  OPERATIONS. 

Fig.  69. — A  view  of  the  disto-buceal  cavity.  Note  the  bevel 
of  the  external  third  of  the  walls  and  the  conformity  of  the  floor 
to  the  wall  of  the  tooth  upon  which  the  cavity  presents. 

Figs.  70  and  71. — Views  of  the  disto-ocelusal  cavity.  Note 
the  acute  angle  formed  by  the  distal  and  occlusal  surfaces.  Note 
the  bevels  and  gingival  seat,  also  the  taper  of  the  cavity. 

Figs.  7l*  and  73. — Occlusal  and  cavo-surface  views  of  the 
finished  inlay  for  the  disto-occlusal  portion  of  the  tooth. 

1'i-s.  74  and  75. — Buccal  and  cavo-surface  views  of  the  disto- 
buccal  inlay. 

Figs.  76,  77,  and  78. — Views  of  the  finished  operations.  Note 
areas  of  immunity  into  which  the  operations  have  been  carried. 

Stress  Index:  Upward,  out  and  backward,  back  and  inward, 
fore  and  outward  or  IXTRAALVEOLAR  BUCCO-DISTALLY  disto-pala- 
t<i!lii  and  m< xin-buccally  or  in  a  latero-rotary  direction. 


98 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Fig.  80. 


Fig.  81. 


Fig.  82. 


Fig.  83. 


Fig.  84. 


Fig.  85. 


Fig.  86. 


CAVITY     I'KKI'AKATIOX  !>!) 


A  MKsio-DiSTO-Orri.rsAL  CAVITY  ix  AX  I'IM-KI;  MOI.AK.  ALSO 
A  I'.rccAi,  CAVITY  ix  THK  SAMI:  TOOTH. 

F'IL;.  "!». — View  of  the  lim-cal  cavity.  Xote  bevel  and  con- 
1'oniiity  nl'  surface. 

Fig.  Si  I. — View  nf  occlusal  surface  of  cavity,  also  showing 
mesial  ami  ilistal  parts  of  it. 

Fig.  81. — Distal  portion  of  cavity  showing  also  the  occlusal 
planes.  Xote  lievels  of  all  surfaces  ami  taper  of  cavity  as  whole. 

Ki»-s.  Mil  ami  M.'!. — Occlusal  ami  cavo-sm  fa:-e  views  of  finisheil 
inlay.  Note  definition  of  occlusai  carving  in  \-'\^.  SL'.  ami  defini- 
tion of  cavn-siirface  in  Fi^.  - 

Fii;.  SI.— Finishi  d  ojieration  upon  Iniccal  surface. 

Fij;-.  80. — Occlnsal  view  of  finished  ojieration  of  nicsio-disto- 
ncclusal  inlay. 

Fig.  80. — View  of  distal  surface  of  completed  operation.  Note 
areas  of  immunity  into  which  the  whole  operation  has  been  car- 
ried. 

Sti ••  ss    Index:      Upward,   out   and   backward,   back   and   inward, 
fore   and   outward   or    I XTKAAI.VKOI.AK   Hrrro-PisT.\u.Y 
t nil ii  and    iit>  xio-bnrt-tillti  or   in    a    latero  rotary  direction. 


100 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Fig.  87. 


Fig.  88. 


CAVITY    PREPARATION*  101 


Figs.  87  and  88. — Two  illustrations  of  teeth  worn  down  by 
attrition,  restored  by  means  of  the  cast  gold  inlay,  imitating  the 
conditions  of  adjacent  teeth.  (Dr.  R.  Ottolengui.) 

Note  the  well-defined  carving  upon  the  occlusal  surfaces  and 
ac(|ii;iint  yourself  with  the  fact  that  definition  does  not  necessa- 
rily mean  depth. 


CAST    G()U>    AND    POIH'KLAIX    INLAYS 


Fig.  89. 


Fig.  90. 


Fig.  91. 


Fig.  93. 


Fig.  94. 


CAVITY    IMIKI'AKATIOX  103 


I.I  KT  FlUST  Lii\VKK  MOJ.AK  J'KKSKNTIX*;  DKKH'IENCV  Of  OC- 
Cl.rSAI.  TlIIKU.  VlK\VS  Il.I.rSTKATINi;  I'KKPAUATIOX  OK  ( '.VV1TY  AXD 

HKSTOKATION  MAIM:  KOK  IT  i\  TIIK  SIIATK  OF  A  CAST  (ioi.n  INI.AV. 

Fig.  89. — Occlusal  view  of  the  cavity.  Xote  tlio  bevels  pre- 
s  ntiiiji1  aruund  tlie  jici  ipliciv  of  the  tootli  ainl  at  the  circumfer- 
ence of  the  cavity.  The  extent  of  the  outer  or  peripheral  bevel  i> 
ei|ii!il  to  one-half  the  depth  of  the  cavity  at  its  deepest  part. 
Xote  the  four  distinct  planes,  to  wit:  The  mesial  plane,  the 
distal  plane,  the  lingual  plane,  ar.d  the  buccal  plane.  X'ote  also 
the  apex. 

Fi^.  !»().—  A  buccal  \ie\\  of  the  cavity  showing  the  apex  of 
the  four  ])lanes  to  be  somewhat  below  the  surface  of  th:1  cavo- 
peripheral  bevel. 

Fij;.   91. — Ofdusal    view   of   the   carved    inlay. 

Fij;.  V'2. — Cavo  surface  view  of  the  inlay.  Xote  the  amount 
of  frictional  contact  between  inlay  and  tooth  gained  by  this 
four-planed  preparation  of  the  floor  of  the  cavity. 

Fi«;s.  !»-'!  and  94. — Views  of  the  finished  operation,  a  power- 
ful and  lasting  restoration. 

Stivss  Index:  Downward,  down  and  outward,  down  in  and 
forward,  down  back  and  inward,  down  fore  and  outward  or 
IXTKAAI.VKOI.AK,  i c  t I'dlnicco  ilixtiill i/.  in! niliiifini>-Hi<  xiitlti/.  intra- 

nii  mtramcsio-bvccally. 


104 


CAST    (JOLD   AND    PORCELAIN    INLAYS 


Fig.  95. 


Fig.  96. 


Fig.  97. 


Fig.  98. 


Fig.  99. 


Fig.  100. 


Fig.  101. 


Fig.  102. 


c:.\VJTV    PREPAKATinX  105 


A  COMIM.KX   CAVITY  ix   AN   UPPKR  MOLAR  INVOLVING  EVERY 

SrRKACK    OF    THE    TOOTH. 

A  CAST  GOLD  INLAY  MADE  TO  RESTORE  THE  TOOTH  TO  USE 
A xi)  ANATOMIC  ACCEPTABLENESS. 

Fig.  95. — A  view  of  the  ocelusal  preparation  of  the  cavity. 
Note  the  occluso-disto-lingual  plane  and  the  occluso-mesio-buccal 
plane. 

Fig.  !t(i. — A  tii'iieral  view  of  the  cavity.  Note  the  well-sup- 
ported enamel,  the  beveled  margins  practically  continuous,  the 
well  defined  steps,  and  the  general  taper  of  the  whole  cavity  as 
shown  in  Figs.  96  and  97. 

Fig.  98. — A  view  of  the  ocelusal  surface  of  the  carved  inlay. 

Fig.  99. — A  cavo-surface  view  of  the  carved  inlay. 

Fig.  100. — An  ocelusal  view  of  the  inlay  in  position. 

Fig.  101. — A  buccal  view  of  the  restoration  showing  how  a 
synthetic  insert  may  be  made  for  this  surface. 

Fig.   102. — A  disto-palatal  view  of  the  finished   operation. 

Stress  Index:  Upward,  out  and  backward,  back  and  inward, 
fore  and  outward  or  INTRAALVKOLAR,  Bucco-DiSTALLY,  disto-pal- 
utaVy  and  mcsio-buccally  or  in  a  latero-rotary  direction. 


CAST  GOLD  AND  POKCELAIN  INLAYS 


Fig.  103. 


Fig.  104. 


Fig.  105. 


Fig.  106. 


Fig.  107. 


Fig.  108. 


Fig.  109. 


Fig.  110. 


Fig.  111. 


CAVITY    PREPARATION 


\I.\K      \1K\\S      OK      A      SKCOMi      LOWKK      MOI.AK      l'KKSKXTIX«J      A 

MKSIO  iMsTO-Ocru'so Hrrcu.    CAVITY     AND    Two    JXTKKI.OCKIXI; 
CAST  GOLD  IM.AVS  MAKK  FOK  IT. 

Fig.  1<>;{. — View  of  tli.-  ccclnsal  surface  prepared  to  present 
the  plan.s  for  added  f rictional  relation  lietween  inlay  ami  t<  oth. 
Note  lievels  presenting  in  all  margins. 

Fi-.  KU. --View  of  distal  part  of  <-avity.  Note  steji.  Ix-vels, 
s  at.  ami  taper. 

Fi_U.  Ido. — Jinccal  view.  Note  lievels  of  outer  third  of 
cavity. 

Fi^.  L06.— Ocelusa]  view  of  mesio-disto-oeclusto  ]>ortion  of 
inlay.  Xote  the  lucking  device  in  it  Inicco-occlusally. 

Fiy.  In7.  C;i \o-surfac.'  view  of  the  !)iiccal  portion  of  the1 
inlay.  Note  lievel  and  lock  to  fit  into  tlu'  part  reiiresented  by 
Fi-.'  106. 

Fig.  108.— Cavo-surface  view  ,.f    Fi^.    ll>«. 

Fi^s.  109,  110,  and  111. — Views  of  the  finished  operation; 
in  sequence,  a  luiccal  vi;'w,  a  niesio-lnu-cal  view  and  an  occluso- 
Imccal  view. 

The  niesio-disto-occhisal  jiortion  of  this  restoration  is  finished 
fir>t  and  cemented  into  position,  thus  making  a  bncfo-occlnsal  cav- 
ity to  lie  con.-idered  for  the  second  operation. 

Stress  Index:  Downward,  down  and  outward,  down  in  and 
forward,  down  hack  and  inward,  down  fore  and  outward  or  IXTKA- 
AI.VKOI.AK.  mtrabucco-dirtatty,  mtrelinffito-mesially,  intradisto-lin- 
gnally  an<l  iiitraine.-io-luiccally. 


108 


CAST    GOLD   AND   PORCELAIN    INLAYS 


Fig.  112. 


Fiff.  113. 


Fig.  114. 


Fig.  115. 


Fig.  116. 


Fig.  117. 


Fig.  118. 


Fig.  119. 


CAVITY    PRF.PAKAT10X  109 


A  MESIO-DlSTO-OCCLUSO-PALATAL  CAVITY  IN  AN  UPPER  MOLAR 
KKSTOKKD  HY  MEANS  OF  A  CAST  GOLD  INLAY. 

Fig.  112. — A  view  of  the  palatal  surface  of  the  tooth.  Note 
the  bevel  on  this  part  of  the  cavity  walls. 

Fig.  113. — A  view  of  the  distal  part  of  the  cavity.  Note 
the  \v<  11  -defined  step,  the  buccal  and  lingual  guides  where  the  inlay 
part  terminates  and  the  unlay  part  begins.  Note  the  taper  of  the 
cavity,  the  bevel  of  the  gingival  seat  and  other  margins. 

Fiji.  1  H- — A  view  of  the  occ-lusal  surface  and  its  planes. 
Note  the  bevel  presenting  upon  this  surface. 

Fig.   115. — Occlusal  view  of  the  carved  inlay. 

Fig.  116. — Cavo-surface  views  of  the  carved  inlay. 

Figs.  117,  118,  and  119. — Views  of  the  finished  operation. 
Note  the  well-defined  occlusal  restoration,  the  restored  bell  shape 
of  the  tooth. 

Stress  Index:      Upward,  out  and  backward,  back  and  inward, 
fore  and  outward  or  INTRAALVEOLAR,  BUCCO-DISTALLY,  disto-pal- 
and  mcsio-buccally,  or  in  a  latero-rotary  direction. 


no 


CAST  GOLD  AND  PORCKLAIX  INLAYS 


Fig.  121. 


Fig.  122. 


Fig.  123. 


Fig.  124. 


Fig.  125. 


Fig.  126. 


Fig.  127. 


CAVITY    PREPARATION  111 


EIGHT  VIEWS  OF  A  MESIO-DISTO-OCCLUSAL  CAVITY  IN  AN  UP- 
PER SECOND  BICUSPID,  AND  THE  CAST  GOLD  INLAY  MADE  FOR  IT. 

Figs.  120,  121,  and  122.— Views  of  cavity.  Note  in  Fig.  120 
the  removal  of  the  weakened  lingual  cusp,  the  beveling  of  the 
margins  occlusally,  lingually,  gingivally,  and  buccally.  Note  care- 
fully in  Fig.  121  the  formation  upon  the  occlusal  surface  of  the 
occluso-disto-liugual  plane  and  the  occluso-mesio-buccal  plane,  and 
in  Fig.  122,  a  view  illustrating  the  taper  of  the  entire  cavity  to 
insure  the  perfect  seating  of  the  inlay. 

Fig.  123. — Occlusal  view  of  the  carved  inlay. 

Fig.  124. — Cavo-surface  view  of  the  inlay.  Note  carefully 
the  definition  of  each  line  and  angle,  and  the  correct  reproduction 
of  the  occluso-disto-lingual  plane  and  the  occluso-mesio-buccal 
plane. 

Figs.  125,  126,  and  127. — Views  of  the  finished  operation. 
Fig.  125  shows  how  the  mesial  portion  of  the  gold  inlay  may,  for 
cosmetic  reasons,  be  replaced  in  the  porcelain. 

Stress  Index:  Upward,  out  and  backward  and  in  and  for- 
ward or  INTRAALVEOLAR,  tabio-distally  and  linguo-mesially. 


112 


CAST  GOLD  AND  POKCELAIN  INLAYS 


Fig.  128. 


Fig.  129. 


Fig.  130. 


Fig.  131. 


Fig.  132. 


Fig.  133. 


Fig.  134.. 


Fig.  135. 


CAVITY    PliKPAHATIOX  113 


EIOHT  VIEWS  OF  A  COMPLEX  CAVITY  IN  AX  UPPER  SECOND 

AND  THK   RKSTOKATIOX   MADE  FOK  IT  IN  THE  SHAPE  OF 
\  CAST  dm.!)  IM.AV.     THE  LABIAL  PORTION  OF  THIS  INLAY  HAS 

I5KKX,    IX    Tl-RX.    I.XLAYKP    WITH    SYNTHETIC   PORCKLAIX. 

Figs.  128,  129,  and    1:50. — Views  of  the  cavity  and  bevels  of 
tlic   various   walls,   margins,   etc. 

Ki.u.    I -"'I. — Occlusal  view  of  the  inlay. 
132. — Cavo-surt'ai-e   view   of  inlay. 

Figs.    133,   134,   135- — Views   of  finished  restoration   showing 
liii;'   of   demarcation    between   gold   and   porcelain. 

Stres>    Index:      reward,  out  and  backward,  in  and   forward  or 

IXTKAALVKOLAK,    lilhiu-tlixtn  II  i/    and    I '  nil  Ho- »l>  .«i<lHl/. 


114 


CAST  GOLD  AND  PORCELAIN  INLAYS 


The  floor  of  all  disto-occlnsal  or  mesio-occhisal  cavities 
should  present  the  appearance  of  an  inclined  plane  instead  of 
a  level  horizontal  surface,  as  this  simple  precaution  will  relieve 
the  vertical  walls  of  any  possible  stress,  and  will  prove  a  great 
factor  in  the  retention  of  an  inlay  placed  upon  the  disto-occlusal 
surface  of  a  tooth  which  has  no  neighboring  teeth  in  opposition 
to  it. 

The  floor  of  all  labio-occlusal  and  lineruo-occlusal  cavities 


Fig.  136. — Stress  index  for  upper  teeth.  Note  in  the  center  of  the  quad- 
rangles representing  the  molars,  the  heavy  black  marks  denoting  intense  intra- 
alveolar  stress,  which  is  lessened  as  the  anterior  part  of  the  mouth  is  approached. 
Left  upper  second  molar  marked  with  letter  P  indicating  this  tooth  as  the  most 
nearly  perfect  one  in  this  upper  jaw. 

should  present  the  appearance  of  an  inclined  plane  instead  of 
a  level  horizontal  surface.  This  is  particularly  essential  and 
even  imperative  where  the  amount  of  dentine,  supporting  the 
enamel  is  small,  and  where  the  cavity  is  of  a  depth  greater  than 
the  thickness  of  these  vertical  walls. 

As  a  guide,  which  will,  of  course,  have  to  he  varied  as  the 
cases  present  themselves,  the  following  table  of  the  different 


CAVITY     PIIKPAItATION  1  1 .") 

directions  in  \vliicli  stress  is  brought  to  hear  upon  the  different 
teeth  is  here  ^iven: 

The  anterior  teeth  in  the  upper  jaw  are  called  upon  to  re- 
sist stress  exercised  against  them  in  an  intraalveolar,  labial, 
and  distal  direction;  that  is,  they  are  constantly  forced  upward, 
outward,  and  backward. 

The   upper  cuspids,   in    a   slightly   intraalveolar,  markedly 


l-'ig.  l.°>7. — Stress  index  fur  l(i\ver  tcoth.  Note  in  the  center  of  the  quad- 
rangles representing  the  molar,  the  heavy  black  marks,  denoting  intense  intraalveolar 
stress,  which  is  lessened  as  the  anterior  teeth  are  approached.  Right  lower  second 
molar  ma  iked  with  the  letter  P,  indicating  this  tooth  as  the  most  nearly  perfect  on 
this  lower  ja\v. 

labial,  and  equally  mesial  and  distal  direction,  so  that  the  lat- 
ter stress  is  practically  balanced. 

Bicuspids,  in  a  markedly  intraalveolar  labio-distal  and  lin- 
Lnio-mesial  or  upward,  outward,  backward,  inward  and  forward 
direction,  the  latter  two  directions  predominating. 

Molars,  in  a  markedly  intraalveolar,  markedly  bucco-distal, 
palato-distal,  mesio-buccal  or,  better,  in  a  rotary  direction,  buc- 
co-distal direction  predominating. 


116  CAST  GOLD  AND  PORCELAIN  INLAYS 

The  lower  teeth  are  called  upon  to  resist  stress  exercised 
upon  them  in  the  following  directions: 

The  four  incisors,  intralingual  and  mesial;  that  is,  the  four 
lower  incisors  are  constantly  being  forced  downward,  and  in  a 
linguo-mesial  direction.  The  downward  pressure  is  counter- 
acted by  the  suspension  ligament,  and  the  lingual  impulse  is 
checked  by  the  ligament  and  the  tongue. 

The  cuspids  are  resisting  a  pressure  tending  to  force  them 
in  an  intra,  mesial,  distal,  and  a  minor  lingual  direction;  or 
downward,  forward,  backward,  and  inward. 

The  bicuspids  are  being  driven  markedly  intra  and  lingual ly 
and  in  a  minor  way,  intradistally  and  intrainesially. 

The  molars  bear  a  stress,  decidedly  intraalveolar  markedly 
intrabucco-distally,  and  intralinguo-mesially,  minor  intradisto- 
lingually  and- intramesio-buccally. 

All  of  these  indications  of  the  direction  of  stress  are  for 
teeth  in  normal,  or  very  nearly  normal,  occlusion;  with  any 
marked  deviation  from  the  normal  occlusion,  will,  of  course, 
have  to  come  a  study  of  the  individual  case  and  a  preparation  of 
the  cavity  to  fill  the  need  of  the  case  at  hand. 

If  the  foregoing  stress  index  is  carefully  noticed  and  mem- 
orized, -deductions  may  be  made  that  will  show  the  direction  of 
stress  which  any  case  presenting  itself  may  be  subjected  to. 
The  best  manner  in  which  this  should  be  done  is  to  take  im- 
pressions in  plaster  of  the  case,  and  obtain  what  are  called 
study  models.  All  the  teeth  needing  attention  having  been  pre- 
viously marked  off  on  a  chart,  the  models  and  the  chart  are 
now  carefully  scrutinized  and  the  teeth  needing  attention  arc- 
marked  off  on  the  models. 

A  close  study  of  the  upper  and  lower  models  individually, 
and  in  their  relation  to  one  another,  is  now  begun,  and  the  cavi- 
ties may  be  outlined  to  their  surface  extent,  if  the  student  so 
desires;  as  a  further  aid,  the  cavities  may  even  be  chiseled  into 
the  plaster  teeth,  as  the  operator  would  have  them  appear  in  the 
mouth.  This  wrould,  of  course,  render  the  models  useless  as 
record  models,  and  would  necessitate  the  taking  of  two  other 
impressions,  or  the  models  at  hand  may  be  reproduced  before 
any  cavity  cutting  is  done. 

This  may  be  accomplished  by  placing  the  model,  which 


Fig. 


Fig.  139. 

Kiy>.  !.".*  ami  ]:>!».-  Huccal  and  lingual  views  of  a  case  of  nearly  normal  oc- 
clusion. Note  tin-  perfect  interdi^itation  of  the  cusps  of  the  upper  and  lower  teeth, 
the  constriction  of  the  teeth  at  the  gingival  circumference,  the  slight  malposition 
of  the  molars  as  manifest  in  the  lack  of  relation  of  upper  third  molar  to  lower  sec- 
ond molar.  (Dr.  .1.  I..->we  Young.) 


118  CAST    COLD    AXD    POIICKLAIX    INLAYS 

has  been  made  perfectly  smooth  with  talcum,  upon  a  glass  slab, 
and  surrounding-  it  with  a  tin  or  brass  or  glass  ring,  about  four 
inches  square  and  about  two  and  one-half  or  three  inches  high. 
Melted  gelatin  is  now  poured  upon  the  model,  covering  the 
latter  completely.  It  will  be  best  to  fill  the  ring.  When  the 
gelatin  has  set,  the  ring  is  inverted,  and  so,  of  course,  is  the 
model.  With  a  sharp  knife  some  of  the  gelatin  is  trimmed  away, 
and  because  of  the  elasticity  of  the  gelatin,  the  model  may  be 
removed. 

Thus  a  gelatin  impression  of  the  model  is  secured,  and  into 
this  impression,  plaster  of  Paris  may  be  poured  and  a  record 
model  obtained. 

In  the  study  of  these  models  for  determination  of  stress, 
the  operator  should  be  in  possession  of  a  complete  history  of 
the  patient.  A  careful  examination  of  the  muscular  structures 
of  the  face  should  be  made  and  the  extent  of  the  freedom  in 
a  laterorotary  direction  enjoyed  by  the  mandible,  should  be 
noted. 

It  must  be  borne  in  mind  that  the  shock  to  a  tooth  under 
stress  mastication  is  inversely  proportional  to  the  elasticity  of 
the  suspension  ligament,  or  the  peridental  membrane,  and  the 
free  mobility  of  the  mandible. 

The  elasticity  of  the  suspension  ligament  is  inversely  pro- 
portional to  the  free  mobility  of  the  mandible.  This  is  a  sec- 
ondary condition  often  resulting  from  a  poor  condition  of  the 
teeth,  finally  affecting  them  to  such  an  extent  that  the  effort 
to  masticate  is  painful,  and  so  the  patient  refrains  from  exer- 
cising the  necessary  pressure  and  shifts  the  mandible  before 
the  maximum  of  pressure  or  tension  required  for  mastication 
has  been  exerted.  This  will,  in  time,  produce  the  condition  of  a 
too  freely  movable  mandible;  and,  because  of  lack  of  proper 
exercise  of  the  peridental  tissues,  pathologic  change  will  take 
place  in  them,  the  effect  of  which  change,  unless  remedied,  will 
be  cumulative,  and  lead  to  the  ultimate  loss  of  the  teeth. 

Upon  restoration  of  occlusal  balance,  the  condition  of  the 
too  freely  moving  mandible  may  be  modified,  if  the  attention 
of  the  patient  be  properly  directed  to  the  importance  of  balance 
between  the  various  factors  in  occlusion. 


1'llKI'AliATlON  1  1!) 


SUMMARY  TOE   CHAPTER  V 
Cavity  Preparation 

1.    Name  surfaces,    line  angles  and   point   angles   of 
(a)    Incisors 
(1))    Cuspids 

(c)  Bicuspids 

(d)  Molars. 

L'.  What    is   meant  by  tlie  iiiiniune  area  of  a  tooth? 

.'!.  Why  are  certain  areas  susceptible  to  decay.' 

I.  Name   the   immune   ar;  a<. 

•~>.  Xanie  the   susceptible   areas. 

(i.  What    factors    inter    into    cavity    preparation.' 

7.  What    are    the    requirements    for    tlie    formation    of    a    cavity    to    receive    a 

cast  gold  inlay  .' 

,s.  What    instruments   arc   necessary    for    pro|ier   cavity    preparation? 

!>.  Name   tlie   g  neral    rules   for   teeth    cutting. 

Id.  What    steps   are   taken   before  the   cavity    preparation  is  commenced? 

11.  Name  the  types  of  cavities  and  their  subdivisions. 

ll".  Kxplain  what  is  meant  by  tin*  surgical  mork  in  the  preparation  of 
cavities.'  The  formative  work?  The  alterative  work? 

}:\.  Why   is  the   anatomic  restoration   of  the  occlusal  surface  necessary? 

14.  How  are  the   margins  of  the  cavity  to  be   prepared? 

].">.  What  general  rule  can  be  applied  to  the  formative  preparation  of  the 
cavity? 

16.  Explain    the    technic    of    the    preparation    of   th  -    cavity   floor   in   teeth   with 

deep    cusps. 

37.  Illustrate  in  cross  section  the  preparation  in  molar  or  bicuspid  of  the 
following  cavities:  (a)  Disto  occlusal,  (b)  Mesio-oeclusal,  (c)  Linguo-occlusal, 
(d)  ]iucco-occlusal. 

18.  Illustrate  in  cn»s  section  the  preparation  in  a  molar  or  bicuspid  of  a 
m:  sio-occluso-disto  linguo-buccal  cavity. 

1!>.    What    is   a    mesial   plane?     What   is   a   distal   plane? 

:2H.   What   is  the  o.-dusodisto  lingual  plane?     What  is  the  mesio-buccal  plane? 

L'l.   (live  the  directions  of  stress  which  the  teeth  arc  called  upon  to  withstand. 

(a)  Upper    inci>or 

(b)  Upper  cuspids 

(c)  Upper  bicuspids 

(d)  Upper  molars 

(e)  Lower  incisors 

(f)  Lower  cuspids 

(g)  Lower   bicuspids 
(h)  Lower  molars. 

"2'2.   What  is  the  purpose  of  7iiaking  study  models? 

-'.'>.  (Jive  the  gauges  and  si/.es  of  supplemental  pins  when  used.  How  would 
you  prepare  these  pins  for  use.'  Why  should  (,he  use  of  these  pins  be  avoided.' 


CHAPTER  VI 

THE  MESIO-DISTO-OCCLUSAL  CAST  GOLD  IXLAY 

THE  CAST  GOLD  COMPLEMENT  FOR  A  TOOTH  PRE- 
SENTING A  MESIO-DISTO-OCCLUSAL  CAVITY 

We  must  recognize  the  inherent  qualities  of  whatever  suit- 
able materials  we  wish  to  use  in  our  work;  never  seek  to  de- 
stroy these  qualities,  but  rather  urge  their  expression  in  a  man- 
ner best  calculated  to  enhance  our  effort. 

This  is  an  abstract  principle,  the  recognition  of  which  will 
save  artists  and  artisans,  as  well  as  those  engaged  in  many  other 
useful  pursuits,  many  discouraging  failures.  It  is  one  of  the 
keystones  in  the  house  of  truth;  one  may  go  further  and  say 
that  it  is  the  very  cornerstone  of  success  in  one's  manual  or 
mental  work. 

The  properties  of  all  things  which  enter  into  inlay  work 
must  be  considered  in  two  ways  or  from  two  angles.  First, 
in  their  oneness,  or  aloneness,  a  state  of  imperious  reserve  and 
haughty  aloofness — the  absolute  state;  and  second,  in  their 
interdependent  copartnership  with  their  coagents  a  state  of  ad- 
justment now  tardy,  now  ready,  now  yielding,  or  impelling  yield, 
finally  in  harmonious  understanding  of  the  properties  of  each 
other,  yielding  their  own  to  acquire  new  ones — the  relative  state. 

In  inlays  made  for  simple  cavities,  or  mesio-  or  disto-oc- 
clusal  cavities,  it  becomes  necessary  to  pit  the  inherent  pressure 
of  the  gas  or  air  used  in  casting  against  the  inherent  inverse 
pressure  of  the  molten  gold.  By  the  inherent  inverse  pressure 
of  the  molten  gold,  is  meant  its  loss  of  cube  dimension  when 
changing  from  a  molten  to  a  solid  state. 

In  considering  gold  and  platinum,  the  former  the  quan- 
titatively predominating  metal  used  in  inlay  work,  we  find  that 
they  are  very  ductile,  royal  metals  subject  to  varying  dimen- 
sional changes,  under  varying  intense  temperatures,  the  maxi- 
mum gain  in  cube  dimension  being  reached  at  the  boiling  point. 

120 


.M  Ksio-msTo-orcM'SAi.  C\ST  coin   I.M.AV  121 

I'pon  removal  of  the  heating  clement,  the  molten  mass  will 
gradually  cool  hy  giving  up  its  inl.-iix-  heat  to  the  air  and  things 
surrounding  it,  and  (luring  the  cooling  process  or  process  of 
crystallization,  will  lose  in  cube  dimensions  the  amount  gained 
while  its  temperature  was  heing  raised  from  room  temperature 
to  boiling  point:  or  simply  this,  gold  and  platinum  will  expand 
on  being  heated  with  maximum  expansion  at  their  boiling  points 
and  will  contract  on  cooling  with  maximum  contraction  on  reach- 
ing room  temperature  again.  This  very  phenomenon  may  ruin 
work  or  may  contribute  markedly  to  the  success  of  it  when  con- 
structing an  inlay  for  a  mesio-disto-occlusal  cavity.  It  depends 
greatly,  if  not  altogether,  on  how  the  cavity  in  the  tooth  to  be 
inh'.ved  is  prepared. 

The  form  of  cavity  preparation  advocated  in  tins  volume 
for  mesio-  or  disto-occlusal  or  for  labio-  or  linguo-occlusal  cav- 
ities will  not  do  for  mesio-disto-occlusal  or  for  labio-linguo-oc- 
clusal  cavities. 

In  all  cavities,  but  the  last  groups,  an  inlay  is  exactly  what 
it.-  name  implies;  in  the  latter  two  groups  it  takes  a  new  form 
unto  itself  when  two  things,  an  inlay  and  an  onlay  are  merged 
into  one.  So  that  a  cast  gold  inlay  complement  for  a  mesio- 
di.-to-ocdusal  or  a  labio-linguo-occlusal  cavity  may  be  truthfully 
called  an  oii-inlay,  the  occlusal  and  the  extreme  inner  or  cavo- 
part  of  the  mesial  and  distal  portion  of  it  being  the  inlav,  and 
the  extreino  outer  part  of  the  mesial  and  distal  portion  of  it, 
that  is,  the  extreme  bnccal  and  lingual  sections  of  the  mesial 
and  distal  portions  of  the  gold  complement  being  the  onlay. 

CAVITY  PREPARATION 

1.  Open  the  occlusal  surface  by  means  of  a  carborundum 
wheel  %-i-  Vir.  of  an  inch  wide  held  in  the  contraangle  handpiece, 
the  stone  is  to  be  run  under  water. 

2.  Remove  the  mesial  and  distal  portions  of  the  tooth  by 
the  use  of  a  safe-sided  carborundum  disc  held  in  the  straight 
or  <  ontraangle  handpiece  as  the  need  presents,  these  discs  to  be 
run  under  water.     Tin  >e  portions  are  removed  in  such  a  man- 
ner that   the  mesial  and  distal  surfaces  of  the  tooth  will  taper 
slightly  toward  the  occlusal. 


CAS'!'    COLD    AND    I'OIH'KLAIX     INLAYS 


Fig.  140. — The  first  cut  after  the  detay  has  Ixv'ii  ivmov; <l  in  the  preparation 
of  a  mesio-occluso-distal  cavity  in  a  molar.  This  is  the  occlusal  cut  and,  barring 
extensive  fissure  involvement,  should  givo  at  once  the  entire  width  of  the  main  cav- 
ity upon  the  occlusal  surface. 


Fig.  141. — The  second  cut,  removal  of  the  mesial  wall,  to  provide  for  the 
onlay  part  of  the  inlay.  Ajoining  this  flat  wall  are  seen  the  lingual  or  palatal  and 
labial  or  buccal  guides,  as  well  as  the  gingival  seat  of  the  cavity.  Note  that  the 
mesial  wall  has  been  cut  so  that  it  tapers  slightly  toward  the  occlusal  wall. 


MKSIO-DISTO-OCCU'SAI.    CAST    COLD    INLAY  1  -'.} 


Fig.  142. — The  third  cut.  The  removal  of  the  distal  wall  to  provide  for  the 
unlay  part  of  the  inlay.  Adjoining  this  flat  wall  are  so;>n  the  lingual  or  palatal 
and  labial  or  buccal  guides,  as  well  as  the  gingival  seat  of  the  cavity.  Note  that  the 
distal  wall  has  been  cut  so  that  it  tapers  slightly  toward  the  occlusal  wall. 


l-'iy.  14:;.  'I'll,-  final  cut.  The  bevel  upon  the  occlusal  surface  continuous  with 
the  nifsio-liuccal,  disto-liuccal,  niesio-lingual.  and  disto-lingual  guides  of  the  cavity, 
which  guides  are  licveled  outward.  An  inlay  made  for  a  cavity  such  as  this  must 
never  he  put  into  position  het'ore  thoroughly  lubricating  it  with  a  small  amount  of 

carholated    vaseline. 


124 


CAST  GOLD  AXI)  PORCELAIN  INLAYS 


Fig.  144. — The  wax  inlay  made  for  the  mesio-occluso-distal  cavity.  It  is 
mounted  upon  a  sprue  wire  and  held  in  the  crucible  former.  Note  reproduction  of 
all  lines  and  bevels  in  the  wax. 


Fig.  145.— The  finished  inlay  in  position  upon  the  tooth.  The  small  amount  of 
contraction  of  the  gold  served  here  to  more  closely  force  the  mesial  and  distal 
onlays  against  the  tooth  surfaces.  This  is  a  hybrid,  not  an  inlay,  but  an  on-inlay. 


MKSlO-DISTO-OCCLrSAL    CAST    COLD    IXLAV  1  -~) 

.">.  Provide  buceal  or  labial  and  lingual  guides,  and  pro- 
vide the  gingival  scat  in  the  cavity  by  means  of  very  thin  cylin- 
drical carborundum  stones  held  in  the  contraangle  handpiece 
and  run  under  water. 

4.  Polish  all  cavity  walls  by  means  of,  first,  coarse  sand- 
paper, followed  by  finer  sandpaper,  and  ultimately  by  fine 
cuttlefish  discs. 

The  removal  of  all  decay  and  all  doubtful  tooth  tissue  is 
imperative  and  should  be  done  before  any  attempt  is  made  to 
prepare  the  cavity  at  all.  The  practice  of  leaving  this  until 
the  last  for  fear  of  creating  undercuts  is  reprehensibly  bad 
practice. 

The  grinding  or  cutting  of  tooth  structure,  e\c«  pt  it  be  done 
with  chisels  before  all  the  decay  lias  been  removed,  is  likely 
to  contaminate  the  as  yet  unaffected  layer  of  dentine,  a  result 
as  undesirable  as  it  is  ultimately  disastrous. 

If  the  saliva  interferes  with  clean  rapid  work,  the  rubber 
dam  must  be  applied. 

All  that  has  previously  been  said  in  the  chapter  on  Cavity 
Preparation  for  simple,  compound,  and  complex  cavities  ap- 
plie.x  in  M.O.I),  cavities;  that  is,  the  adjoining  teeth  must  be 
scaled  and  polished,  and  by  far  the  best  way  is  to  subject  the 
patient's  mouth  to  a  thorough  prophylactic  treatment.  The 
dam  may  then  be  applied  and  the  cavity  preparation  undertaken 
and  completed  as  directed. 

The  tooth  should  then  be  washed  with  warm  water,  until 
no  sign  of  d<  hris  exists;  tooth  and  cavity  are  now  flooded  with 
alcohol  (!).V,  )  and  dried  with  a  gentle  warm  air  blast.  A  gen- 
erous quantitiy  of  chloroform  is  now  applied  and  again  the 
warm  air  is  used  to  dehydrate  the  tooth  presenting  the  cavity. 
The  next  application  consists  of  a  saturated  solution  of  potas- 
sium carbonate  in  glycerine  Hooding  every  part  of  the  cavity— 
'his  solution  is  allowed  to  remain  in  the  cavity  for  about  five 
minutes,  when  the  warm  air  is  again  applied. 

The  glycerine  will  further  dehydrate  the  dentinal  tubules, 
and  the  carbonate  of  potash,  held  in  solution,  will  enter  to 
efficiently  occlude  these  with  a  material  acceptable  to  the  tooth 
economy. 

In   order  to  exclude   the   possibility   of  thermal    shock,   this 


lL!()  CAST    COLD    AND    rOIICKLAl.X     INLAYS 

procedure  may  be  followed  up  with  a  solution  of  rosin  in  chlo- 
roform, y*  dram  of  rosin  to  4  drams  of  chloroform.  This  makes 
a  very  tough  varnish,  which  will  cling  to  the  dentine  walls  in 
the  cavity,  and  which  will  enter  the  •dentinal  tubules  to  some 
extent.  It  is  a  nonconductor  of  thermal  changes  and  will  pre- 
vent shock  to  the  tooth  when  the  inlay  is  set  and  after  it  has 
been  set.  This  varnish  may  be  applied  with  a  pellet  of  cotton 
and  it  must  be  dried  with  the  warm  air. 

AYhen  all  these  preparations  have  been  completed,  we  may 
proceed  to  band  the  tooth  or  put  a  matrix  on  it  and  to  force 
the  wax  into  the  cavity — that  is,  we  may  proceed  to  make  the 
wax  inlay. 

This  should  be  done  by  the  direct  method  as  already  de- 
scribed, or  by  the  use  of  the  indirect  as  an  accessory  to  the  di- 
rect as  also  described. 

The  mode  of  cavity  preparation  advocated  and  illustrated 
here  for  mesio-occluso-distal  and  B.O.L.  inlays  takes  into  con- 
sideration and  partnership  the  small  amount  of  contraction  that 
will  take  place  in  the  casting  of  the  metal  and  make  use  of  this 
property  of  the  metal,  in  that  thus  a  better  coaptation  is  ob- 
tained between  inlay  and  tooth. 

This  preparation  will  not  do  for  mesio-occlusal,  disto- 
occlusal,  bucco-  or  linguo-occlusal  cavities,  because,  in  getting 
a  closer  adaptation  mesially  or  distally,  buccally  or  lingually, 
the  gold  would  be  pulled  away  from  the  margins  upon  the 
occlusal  surface,  and  the  margins  upon  this  surface  would  be 
exposed  to  the  recurrence  of  decay. 

SUMMARY  FOR   CHAPTER   VI. 
The  Mesio-Disto-Occlusal  Cast  Gold  Inlay 

1.  Describe  the  preparation  of  an  M.O.D.  cavity. 

2.  Describe  the  preparation  of  the  cavity  for  the  reception  of  the  \\:ix. 
.'5.  Describe  the  taking  of  the  impression. 

4.  What  quality  of  the  casting  metal  is  recognized  in  the  preparation  of 
mesio-disto-occlusal  or  a  bnceo-occluso-lingual  cavity? 


CIIAPTKU   VII 
THK  SKLKCTIOX  OK  TIIK  PliOl'KU   WAX 

\\'a\  is  a  name  given  to  various  animal  excretions  or  vege- 
table substances  having  some  similar  and  some  identical  phys- 
ical  peculiarities,  but  differing  in  chemical  coni])osition,  and 
possessing  a  delinite  physical  individuality. 

All  waxes  are  hydrocarbon  compounds,  related  to  the  groups 
of  oils  and  fats,  common  wax  differing  from  ordinary  wax  in 
pos>essing  no  glycerine. 

A  great  many  waxes  are  known  to  commerce  and  employed 
in  the  arts. 

The  most  widely  known,  or  common  wax,  which  forms  the 
honeycomb  of  the  wonderful  bees,  is  in  its  untampered-with 
condition,  a  comparatively  hard  substance,  unctuous  to  the 
touch,  tasteless,  and  of  a  sweet  odor.  It  is  easily  obtained  from 
the  combs  by  immersing  them  in  hot  water,  when  the  wax  will 
float  to  the  surface  as  a  thin  oily  fluid.  This  fluid  is  drawn  off 
and  allowed  to  solidify  into  cakes.  This  wax  may  be  bleached 
or  purified  into  cera  alba  or  white  wax,  by  the  following 
process : 

In  the  shape  of  thin  flakes,  the  wax  is  exposed  to  the  air 
and  light  until  the  surfaces  of  the  flakes  have  been  bleached, 
much  after  the  process  used  in  bleaching  linen.  The  wax  is  then 
remelted.  and  thus  new  surfaces  are  brought  under  the  bleaching 
influence  of  light  and  air.  This  is  continued  until  a  uniform 
white  wax  is  obtained. 

Bleaching  powders  as  chemical  agents,  are  sometimes  used, 
but  they  are  objectionable  because  the  whole  of  the  chloride  is 
not  removed  in  the  process,  and  in  the  subsequent  burning  of 
the  wax,  irritating  and  harmful  fumes  of  hydrochloric  acid  an- 
given  off. 

\Vhite  wax  made  pure  by  the  process  of  boiling  and  bleach- 
ing consists  of: 

127 


128  CAST  GOLD  AXD  PORCELA1X  IXLAYS 

Creatine,  80  per  cent,  soluble  in  boiling  alcohol  and  an  in- 
soluble waxy  substance  called  inyricin,  nearly  20  per  cent.  A 
small  proportion  of  cerolin  gives  hardness  to  the  mass. 

The  wax  is  tasteless,  inodorous  and  semitransparent.  At 
85°  F.  it  becomes  somewhat  plastic,  and  may  be  molded  with 
the  fingers.  It.  melts  at  145°  F.  It  is  chiefly  used  for  making 
candles,  artificial  flowers,  and  wax  fruits.  It  has  emollient 
properties  and  is  employed  in  the  making  of  ointments.  Because 
of  its  high  price,  it  is  often  adulterated  with  spermaceti  (an 
inferior  wax  chalk),  starch  and  finely  powdered  si  lex,  etc. 

Another  wax  is  made  from  candleberry,  known  as  wax 
myrtle,  wax  or  tallow  tree,  or  bayberry  (Myrica  Cerifera),  a 
small  tree,  or  more  generally  a  low  spreading  shrub,  a  native 
of  the  United  States,  most  abundant  and  luxuriant  in  the  South. 
The  evergreen  leaves  are  dotted  with  resin  glands,  and  are 
fragrant  when  bruised.  The  drupes,  popularly  called  berries. 
are  about  the  size  of  peppercorns,  and,  when  ripe,  are  covered 
with  a  greenish  white  wax.  The  wax  is  collected  by  boiling  and 
skimming  them,  and  is  afterwards  melted  and  refined.  A  bushel 
of  berries  will  yield  four  or  five  pounds.  An  excellent  scented 
soap  is  made  from  it. 

Paraffine  was  practically  unknown  to  the  candle  maker  un- 
til 1847-50,  when  the  late  Dr.  James  Young  discovered  the 
method  of  producing  hydrocarbons  by  the  distillation  of  coal 
at  a  low  red  heat.  It  is  now  produced  in  Scotland  from  shale 
in  large  quantities;  in  the  United  States,  from  petroleum;  in 
Germany  (in  smaller  quantities),  from  brown  coal;  and  in 
Burma,  in  yet  smaller  quantities,  from  rangoon  petroleum. 
Crude  paraffine  (technically  "scale")  contains,  in  addition  to 
the  harder  paraffine  suitable  for  candles,  soft  paraffine  (used 
by  match  makers),  and  a  small  proportion  of  oil.  The  scale  is 
melted  and  cast  into  thin  cakes,  which  are  then  placed  on  slop- 
ing shelves  in  an  oven  kept  at  a  regular  temperature  sufficiently 
high  to  melt  the  soft  paraffine.  The  soft  paraffine  and  oil  flow 
away,  and  leave  behind  a  mass  of  hard  paraffine  ready  for  the 
candle  maker. 

Mineral  wax  is  a  name  employed  for  certain  fossil  hydro- 
carbons, occurring  chiefly  in  small  quantities  in  carboniferous 
formation.  The  commonest  one  of  these  is  ozokerite,  used  in 


SKLKCTIOX    OK    TIN-:    IMIOI'KI!    \\'A.\  1  1}!) 

the  candle  industry.  A  preparation  of  this  substance  known  as 
oiokcf'nic,  is  employed  in  Hi"  making  of  ointments.  It  lias  the 
advantage  over  lard  for  this  purpose  as  it  do*  s  not  spoil  with 
time  and  age,  and  does  not  turn  rancid. 

There  is  a  great  variety  of  these  vegetable  and  mineral 
waxes,  hut  these  enumerated  will  suffice  to  enable  the  reader 
to  learn  something  of  the  origin  and  properties  of  the  most 
widely  known  to  the  arts  and  commerce. 

It  must  he  said  that  ,iu  and  by  themselves  none  of  these 
waxes  are  suitable  for  inlay  purposes,  because  for  this  purpose, 
the  wax  must  possess  the  following  properties: 

1.  It  must  leave  absolutely  no  residue  within  the  mold  after 
it  has  been  subjected  to  the  proper  amount  of  heat. 

2.  It  must  volatilize  at  a  temperature  much  below  that  at 
which  the  disintegration  of  the  mold  begins. 

3.  It  must  remain  rigid  at  25°  F.  above  the  temperature  of 
the  mouth,  which  means  that  it  will  break  before  it  will  bend. 

4.  It    must    possess   when    heated,   the   property  of  perfect 

plasticity. 

.").   It  mu>t  not  flake  when  brought  to  a  plastic  state. 

6.  It  must  be  of  a  dark  shade,  preferably  green,  so  as  to 
more  easily  detect  marginal  deficiencies. 

7.  It  must  be  capable  of  being  willed  to  with  hot  instru- 
ments. 

8.  It  must  he  subject  to  the  least  possible  variation  in  bulk 
at  slightly  above  or  slightly  below  normal  temperature. 

9.  It  must  permit  of  being  carved  to  sharp  definition  of 
outline. 

10.  It  must  be  reliable  in  these  qualities  so  that  the  worker 
may  be  enabled  to  definitely  duplicate  his  operations. 

These  properties  are  possessed  by  no  single  wax,  and  so  a 
combination  of  waxes  had  to  be  carefully  studied  out  and 
experimented  with  in  order  to  obtain  the  desired  results. 

A  simple  stellate  cavity  was  prepared  in  a  molar  tooth  and 
wax  inlays  were  made  for  it  from  the  various  waxes  offered 
to  the  profession. 

These  wax  inlays  were  invested  in  the  refractory  com- 
pounds, one  inlay  at  a  time.  A  separate  mix  of  investment  was 
made  for  each  inlay.  As  nearly  as  possible,  physical  conditions, 


130  CAST  GOLD  AND  PORCELAIN  INLAYS 

such  as  quantity  of  powder  and  water,  and  relative  proportions, 
as  well  as  temperature,  were  duplicated  in  each  instance,  and 
the  automatic  mixer  was  used. 

It  must  be  apparent  that  if  the  precautions  of  making  a 
separate  mix  of  investment  for  each  inlay  had  been  omitted,  and 
if  an  attempt  had  been  made  to  invest  several  of  the  wax  pat- 
terns at  one  time,  the  physical  conditions  and  environments  of 
the  second  mold  would  have  been  different  from  those  of  the 
first,  and  the  conditions  governing  the  third,  fourth,  fifth  and 
sixth,  etc.,  would  all  have  varied  from  those  of  the  first,  and 
from  those  of  each  other,  and  any  deductions  made  from  such 
experiments  would  necessarily  have  carried  with  them  an  ele- 
ment of  guess  and  surmise,  which  from  my  point  of  view  would 
have  rendered  them  altogether  unreliable. 

It  is  always  Avell  to  remember  that  the  fluidity  or  creamy 
consistency  of  the  mixed  refractory  compound  changes  as  the 
moments  pass,  and  what  may  be  practically  a  fluid  at  the  time 
of  investment  of  the  first  wax  inlay,  would  prove  to  be  but  a 
plastic  compound  at  the  investment  of  the  third  or  fourth  pat- 
tern, and  its  plasticity  would  be  a  rapidly  disappearing  a*nd 
hence  much  interfering,  quality  of  very  doubtful  merit. 

Each  mix  was  given  an  even  half  hour  to  harden  and  each 
flask  was  subjected  to  the  flame  of  the  Bunsen  burner  under  a 
"Platcheck  stove." 

Upon  casting,  it  was  found  that,  at  a  temperature  that 
would  not  endanger  the  integrity  of  the  mold,  most  of  the  waxes 
left  a  residue  that  excluded  the  possibility  of  satisfactory  re- 
sults, and  that,  in  order  to  clear  the  molds  of  this  residue,  the 
temperature  had  to  be  raised  to  a  degree  that  made  the  mold 
too  weak  to  resist  internal  pressure,  thus  obliterating  margins 
and  producing  a  casting  unfit  for  use. 

These  experiments,  carried  on  for  a  lengthy  period  of  time, 
justify  my  conclusion  that  up  to  the  present,  the  Taggart  green 
wax  is  the  most  ideal  wax  with  which  to  work. 

SUMMARY  FOR  CHAPTER  VII 
The   Selection  of  Proper  Wax 

1.  What  is  a  wax? 

2.  What  are  the  properties  a  wax  must  possess  to  make  it  suitable  for  inlay 
purposes? 


CHAPTER  VIII 

MAKIXC  AND  CARVING  OF  THE  WAX  INLAY  BY  THE 
USE  OF  THE  DIRECT  METHOD 

The  wax  may  be  brought  to  the  proper  state  of  plasticity 
by  dry  or  moist  heat,  greater  care  being  necessary  if  the  direct 
Maine  is  used. 

1'ntil  an  automatic  wax  warmer  made  on  correct  principles 
is  readily  obtainable,  hot  water  heat  is  to  be  preferred  and  a 
serviceable  wax  warmer  and  softener  may  be  made  by  taking  a 
small  glass  with  a  diverging  or  flaring  month,  and  fitting  into 
it  a  cork  of  a  size  that  will,  upon  partly  descending  into  the 
glass,  also  act  as  a  cover  to  retain  the  heat  present  there. 

Bankers'  pins  are  inserted  into  the  cork  and  are  allowed 
to  so  penetrate  it  that  the  points  wrill  reach  into  the  hot  water. 
The  cones  of  wax  are  then  speared  upon  these  pins,  and  the 
cork  carrying  the  pins,  which  in  turn  carry  the  wax,  is  now  al- 
lowed to  drop  into  the  glass  containing  the  water  at  a  tempera- 
ture of  140°  F. 

The  wax-laden  cork  will  float  and  will  allow  the  hot  water 
to  play  around  the  impaled  wax  and  evenly  soften  it.  , 

A  wire  loop  or  glass  pin  push  button  placed  upon  the  top 
or  outside  of  the  cork  will  facilitate  the  handling  of  it.  In 
about  two  minutes  the  wax  will  be  plastic  enough  to  be  used. 

It  is  now  removed  from  its  pin,  and  with  the  pressure  of 
thumb  or  index  finger  it  is  forced  into  the  cavity.  The  pres- 
sure is  to  be  exercised  in  one  direction  only  and  that  is  in  the 
direction  of  the  floor  and  perpendicularly  to  the  walls  of  the 
cavity. 

While  the  wax  is  being  forced  into  the  cavity,  lubricated 
icitJi  (i  solution  of  castor  oil  and  glycerine,  half  and  half,  it  will 
gradually  begin  to  stiffen;  and  when  the  finger  or  thumb  has 
flattened  the  surplus  of  it  against,  the  tooth  surface,  a  stream 

131 


132 


CAST    GOLD    AND    PORCELAIN    INLAYS 


Fig.  146. — The  Taggart  automatic  wax  warmer. 


HIIIKCT    .MKTIIOH    OF    CAKVIXi;    \V.\\     INLAY 


DKSCKJPTIOX  OK  T.\(;«;AKT  ATTOMATIC  WAX   WAK.MKK 
Sfc  e    opposite    page) 

"This  instrument,  an  automatic  wax  warmer,  has  as  a  heat- 
ing clement  a  Hi-candle-power  lamp,  with  a  carbon  filament.  The 
carbon  filament  is  being  abandoned  for  lighting  purposes,  because 
it  furnishes  more  heat  than  light.  The  Tungsten  filament  fur- 
iii-h  s  more  light  than  it  dues  heat.  For  that  reason  I  have  used 
the  carbon  filament  to  furnish  the  heat. 

"The  principle  on  which  it  works  is  this:  We  have  here  a 
glass  disc,  which  we  can  turn  to  one  side  in  order  to  place  our 
wax  mi  it-  On  account  of  the  heat  all  coming  from  one  direction, 
a  mi-tal  disc  or  surface  that  was  Mat  would  receive  heat  upon  its 
upper  surface,  and  the  under  surface  of  the  wax  would  be  cool. 
I  found  that  one  of  thcs  •  di>c  gla-se.s  is  thin  enough  so  that  as 
the  heat  strikes  it.  it  is  reflected  back  so  that  the  under  side  of 
the  wax  is  warmed  as  well  as  the  upper.  I  have  had  wax  on  here 
for  fifty  six  hours  at  a  time,  and  when  I  examined  it,  it  was 
plsatic  in  its  mass,  and  no  more  heated  on  the  upper  than  on  the 
lower  side. 

"The  electric  heating  apparatus  was  hard  to  control  auto- 
matically if  the  current  was  allowed  to  go  in  a  continuous  path, 
but  by  adopting  the  principle  I  have  used  here,  of  having  the 
heat  all  on  or  all  off,  it  permits  the  intermittent  heating  of  a  ther- 
mostat. It  heats  the  thermostat,  and  as  soon  as  it  gets  a  little  too 
warm  it  breaks  the  electric  circuit.  As  soon  as  tli?  electric  circuit 
is  broken  the  thermostat  logins  to  cool  down,  and  the  thermostat 
throws  the  current  into  the  lamp  ai'.ain.  It  works  by  excessive 
heat,  and  it  shows  there  is  not  a  one-hundredth  degree  of  differ- 
ence in  temperature  between  the  surface  on  one  si'V  or  the  other. 
Sometinus  it  will  flash  50  or  60  times  in  a  minute;  sometimes 
slower.  The  ivason  is.  it  is  a  very  sensitive  test  of  the  voltage 
that  is  passing  through  the  wire.  You  liav.?  often  noticed  that 
when  the  lights  would  go  up  high  it  would  make  your  room  light 
enough.  When  the  current  is  at  a  high  voltage  the  lamp  is 
heated  more,  and  that  works  the  thermostat  quicker  and  as  soon 
as  it  is  worked  quicker  it  immediately  drops'  down.  The  dancing 
you  see  is  worked  by  that  voltage. 

"The  wax  is  placed  on  this  glass  disc  and  the  even  tem- 
perature throughout  the  whole  mass  lias  a  great  deal  more  to 
do  with  the  correct  molding  of  wax  in  a  tooth  cavity  than  you 
think.  It  is  peculiar,  but  a  soft,  wobbly  condition  of  the  surface 
of  wax  will  invariably  make  it  shrink  from  the  cavity  walls; 
whereas,  if  you  have  a  wax  of  uniform  texture,  it  will  move  to 
its  plac;>  in  an  exact  way,  and  there  will  be  no  change  in  form 
when  it  cools  off."  (Taggart — Items  of  Interest,  June,  1911.) 


134 


CAST    GOLD   AND   POIU'KLAIX    INLAYS 


of  cold  water  is  directed  upon  it  and  the  force  which  compelled 
it  to  assume  its  new  shape  is  removed. 

An  explorer  may  now  be  inserted  into  the  body  of  the  wax 
inlay  and  it  may  be  withdrawn  to  be  carefully  examined. 

If  the  wax  was  in  the  proper  plastic  condition,  and  all 
directions  have  been  carefully  followed,  the  wax  inlay,  if  the 
cavity  be  simple,  will  be  a  perfect  impression  of  the  cavity,  and 
it  may  be  replaced  in  the  tooth  to  assume  its  final  shape,  which 
will  be  a  perfect  wax  complement  to  the  macroscopic  anatomy  of 


Fig.  147. — A  glass  of  water  at  a  temperature  of  140°  F.  A  large  cork  carry- 
ing two  banker's  pins  upon  which  two  pieces  of  inlay  wax  are  impaled.  A  pin  to 
serve  as  a  handle  inserted  into  the  upper  surface  of  the  cork.  The  two  pieces  of  wax 
are  constantly  submerged  in  the  water.  The  cork  seals  the  glass  and  keeps  the 
temperature  more  or  less  constant  for  an  appreciable  length  of  time. 

the  tooth,  and  which  shape  is  created  with  carvers  and  bur- 
nishers of  the  different  patterns  illustrated. 

With  a  pellet  of  cotton  dipped  into  oil  of  cajeput  or  alco- 
hol, and  deprived  of  most  of  its  oil  or  contents  by  rolling  the 
pellet  in  a  towel  or  napkin,  the  wax  inlay  is  finally  polished, 


DIRECT    .MKTHol)    OF    C.MIVIX.:    \VA\     INLAY  1  .'!•") 

care  being  exercised  to  always  polish  towards  the  margins  of 
the  cavity. 

Again  the  explorer  is  inserted  into  the  body  of  the  wax. 
midway  between  all  margins,  and  the  wax  inlay  is  removed 
from  the  mouth,  to  he  transferred  to  a  glass  of  cold  water  until 
it  can  he  surrounded  with  and  imbedded  in  the  refractory  com- 
pound. In  a  very  delicate  wax  inlay,  it  is  wiser  to  use  coin- 
pivs>ed  air  to  remove  it  from  its  seat  in  the  cavity;  this  can 
readily  be  done  by  applying  the  blast  of  air  at  the  cervical  part 
of  the  inlay. 

In  compound  cavities  the  technic  of  preparing  the  wax  for 
the  making  of  tlie  wax  inlay,  is,  of  course,  the  same,  except  that 
the  tooth  is  banded  in  extremely  large  restorations,  when  it 
becomes  necessary  to  join  two  or  more  of  the  cones  of  wax  in 
order  to  obtain  a  piece  large  enough  for  the  inlay,  and  some 
surplus  against  which  to  apply  the  force. 

AYhen  this  becomes  necessary,  two  cones  of  the  softened 
wax  are  brought  together  at  their  base,  and  a  hot  spatula  is 
drawn  longitudinally  through  both  cones  at  four  or  five  places 
on  the  circumference,  and  twice  through  the  joints  of  the  cones 
horizontally.  This  will  result  in  an  inseparable  piece  of  inlay 
wax  twice  the  usual  size. 

If  the  piece  has  stiffened  too  much  in  the  process  of  han- 
dling, it  is  again  impaled  upon  the  pin  and  placed  in  the  hot 
water  to  become  properly  plastic. 

The  large  piece  of  wax  is  now  removed  from  the  water 
bath  and  forced  into  the  cavity,  care  being  taken  to  exercise  the 
pressure  in  one  direction,  that  of  the  floor  of  the  cavity,  and 
perpendicularly  to  the  walls  of  it  and  the  band  which  sur- 
rounds it. 

The  wax  will  gradually  cease  to  yield  to  the  pressure,  and 
while  the  force  is  still  in  place,  the  wax  must  be  chilled  with  a 
stream  of  cold  water. 

In  this  manner  the  handling  of  wax  is  brought  about  under 
pressure,  and  thus  the  shrinkage  and  expansion  of  waxes,  so 
much  talked  and  written  about,  and  worked  up  into  red  letter 
scareheads  by  investigators  who  shoot  off  at  a  tangent,  really 
deserve  no  consideration  at  all  if  the  technic  laid  down  by  the 
originator  of  the  process  be  followed  to  the  letter. 


136  CAST  GOLD  AND  PORCELAIN  INLAYS 

To  repeat  a  point  to  be  carefully  observed:  the  easiest  A\ay 
to  make  a  wax  inlay  for  compound  or  complex  cavities  is  to 
convert  them  into  simple  cavities  by  placing  a  copper  band  over 
and  around  them. 

These  bands  may  be  made  up  in  quantities  out  of  sheet 
copper  36-gauge  B&S  and  kept  on  hand,  or  a  matrix  such  as 
illustrated  in  Figs.  349  and  150  .may  be  used. 

The  case  presenting  itself,  a  band  of  suitable  size  is  selected, 
trimmed  to  gingival  contour,  and  placed  over  the  tooth  after 
the  cavity  has  been  prepared. 

The  softened  wax  may  then  be  forced  into  the  cavity  against 
the  walls  of  the  band,  the  pressure  may  then  be  removed  and 
a  stiff  cone  of  wax  may  be  forced  into  the  mass  within  the  band, 
the  center  of  the  mass  having  first  been  softened  with  a  suitable 
hot  instrument. 

It  may  be  well  to  reiterate  here  that  the  wax  is  thoroughly 
plastic  that  is  forced  into  the  cavity,  the  pressure  being  ex- 
ered  in  one  direction,  and  that  while  the  force  is  still  upon  and 
behind  it,  it  is  greater  than  the  force  acting  upon  the  molecular 
structure  of  the  wax  in  its  attempt  to  shrink  or  alter  its  form; 
thus  the  deleterious  part  of  the  shrinking  force  or  tendency 
will  be  overcome,  and  the  result  will  be  a  wax  filling,  occupying 
every  part  of  that  cavity  and  abutting  all  margins  accurately. 
It  again  becomes  a  question  of  two  forces  acting  in  opposite 
directions  upon  a  movable  body  (the  wax),  and  it  must  be 
clearly  seen  that  the  greater  force,  if  properly  applied,  will 
prevent  any  change  of  form  in  the  wax,  in  the  wrong  direction 
after  it  has  induced  it  (the  wax)  to  assume  a  certain  definite 
shape ;  to-wit,  that  of  the  cavity. 

At  this  time  the  various  margins  occupy,  or  should  occupy, 
the  operator's  entire  attention.  With  the  proper  carvers,  all 
marginal  surplus  of  wax  is  removed.  With  right  and  left  bur- 
nishers and  always  in  direction  of  the  various  margins  that  part 
of  the  work  is  completed  before  we  proceed  with  the  carving  of 
the  occlusal  surface  in  order  to  restore  occlusal  balance. 

A  large  ball  or  egg-shaped  burnisher  is  heated  in  the  gas 
or  alcohol  flame,  or  it  may  be  attached  to  the  switchboard,  and 
the  occlusal  surface  of  the  wax  inlay,  resting  in  the  cavity,  is 
softened  sufficiently  to  enable  the  patient  to  occlude  and  tritu- 


DIHKCT    .MKTIIOD    OF    t'AltVINU    \V.\X     INLAY 


1:57 


Fig.  148. — A  spatula,  a  set  of  right  and  left  and  straight  flat  burnishers,  lancets, 
right  ami   left   <-;uvcrs.  ami   hand  drills  used  by  the  author. 


138  CAST  GOLD  AND  PORCELAIN  INLAYS 

rate;  if  the  wax  be  lacking  in  bulk,  a  portion  may  be  added. 

In  the  case  of  an  inlay  for  a  lower  tooth,  we  simply  place 
a  piece  of  inlay  wax  upon  the  occlusal  surface  of  the  wax  inlay, 
and  with  the  hot  burnishers  the  two  waxes  are  united. 

In  an  upper  case,  it  is  advisable  to  first  soften  the  occlusal 
surface  of  the  wax  inlay  in  place,  and  then  carry  an  additional 
piece  of  the  wax  into  the  softened  surface.  The  union  is  com- 
pleted by  again  using  the  hot  instrument  and  virtually  melting 
the  added  portions  into  the  wax  inlay. 

When  the  required  bulk  is  obtained,  and  sufficiently  sof- 
tened, the  patient  is  allowed  to  occlude  and  to  triturate,  and 
again  to  simply  occlude  and  hold  that  position  while  a  stream 
of  cold  water  fixes  the  wax. 

None  but  the  occlusal  surface  will  undergo  any  change,  all 
margins  will  be  found  undisturbed,  since  the  softening  process 
was  not  carried  to  any  marginal  portion. 

When  the  maxillary  tension  is  removed  and  the  mouth 
opened,  the  proper  landmarks  for  occlusal  carving  will  be 
clearly  indicated  and  must  be  rigidly  adhered  to,  if  an  occlusal 
surface  that  will  be  truly  serviceable  in  the  full  sense  of  the 
word  is  to  be  obtained. 

SUMMARY  FOR  CHAPTER  VIII 
Making  and  Carving  of  the  Wax  Inlay  "by  the  Use  of  the  Direct  Method 

1.  Describe  a  method  of  bringing  the  wax  to  the  proper  state  of  plasticity 
by  moist  heat. 

2.  Describe  the  method  of  making  the  wax  pattern  if  the  cavity  is  a  simple 
one. 

3.  Explain    the   details   of  preparing   the   pattern   for   compound   or    complex 
cavities. 

4.  Describe  the  finishing  of  the  margins. 

5.  Describe  the  technic  of  carving  the  pattern  to  restore  the  occlusal  surface. 


CHAPTER  IX 

TAKING  AN  IMPRESSION  OP  THE  CAVITY  AND 

MAKIXC  A  DIE  FOR  PROCEDURE  BY  THE 

INDIRECT  METHOD 

The  problem  of  making  a  cast  gold  inlay  by  means  of  the 
impression  or  indirect  method,  should  really  not  be  considered 
as  a  problem  by  itself,  because  as  such  it  at  present  admits  of 
no  solution  worthy  of  the  name. 

If  used  at  all,  it  should  prove  but  an  accessory  step  in  the 
direct  method,  and  so  be  employed  in  cavities  so  inaccessible, 
and  under  circumstances  so  remote  that  the  infrequency  of  these 
stipulations  shall  in  themselves  exclude  it  from  the  routine  of 
daily  work. 

Some  disto-occlusal  cavities  in  the  third  molars  may  call 
for  the  indirect  method  as  an  aid  to  the  direct,  but  under  no 
circumstances  should  sufficient  reliance  be  placed  on  an  im- 
pression of  such  a  cavity  to  complete  the  inlay  upon  a  die  made 
from  this  impression,  without  giving  the  wax  its  final  shape  in 
the  cavity  itself. 

The  very  name  which  the  advocates  of  this  method  have 
given  it,  namely,  the  indirect  method,  in  itself  stamps  it  as 
soi net! ling  remote,  far  off;  labor  and  time  and  energy  are 
wasted  in  attempts  to  have  an  assistant  assume  that  part  of 
the  constructive  work  in  the  laboratory  which  should  be  done 
right  in  the  mouth. 

These  advocates  who  claim  satisfactory  results  from  their 
procedure,  are  being  misled  by  burnished  margins  of  their  in- 
lays; they  lose  all  frictional  relation  between  their  product  and 
the  cavity  it  is  to  occupy,  but  they  honestly  overlook  the  fault, 
grave  though  it  be,  because  the  method  shifts  responsibility  to 
give  time  to  work. 

The  fact  is,  that  if  no  better  inlay  could  be  made  than  the 
best  which  have  been  made  up  to  date  by  means  of  the  indirect 

139 


140  CAST  GOLD  AND  PORCELAIN  INLAYS 

method,  the  entire  process  of  cast  gold  inlays  would  be  a  medi- 
ocre palliative  measure,  instead  of  the  greatest  boon  to  the 
dentistry-requiring  public,  and  if  that  had  been  the  best  it  were 
possible  to  obtain,  I  doubt  much  if  it  would  ever  have  been  given 
to  the  profession  at  all. 

The  first  step  in  the  construction  of  an  inlay  is  to  take  a 
perfect  impression  of  the  properly  prepared  cavity.  If  the 
direct  method  is  to  be  employed,  that  impression  must  be  taken 
in  the  inlay  wax.  If  the  indirect  method  is  to  be  employed,  the 
initial  impression  is  taken  in  a  modeling  compound,  preferably 
"Detroit." 

The  most  persistent  argument  of  the  advocates  of  the  in- 
direct method  is  that  they  can  not  get  a  proper  pattern  of  the 
cavity  in  using  the  direct  method;  in  other  words,  they  can 
not  get  a  perfect  impression  of  that  cavity  in  inlay  wax. 

If  that  be  true,  how  does  it  happen  that  they  can  get  what 
they  consider  a  perfect  impression  in  a  compound,  not  nearly 
so  reliable  in  its  physical  properties  as  is  the  wax  they  should 
use. 

When  the  direct  method  is  employed,  the  margins  of  the 
cavity  in  the  tooth  are  an  ever  present  help  to  thorough  work, 
and  an  ever  present  deterrent  to  the  slip-shod,  just-as-good 
results. 

Once  the  margins  are  obtained,  the  major  part  of  the 
carving  may  be  done  outside  of  the  mouth,  and  the  wax  inlay 
replaced  from  time  to  time  to  insure  correctness  of  manipu- 
lation. 

Proper  occlusion  may  be  obtained  beyond  the  question  of 
a  doubt,  and  that,  without  the  additional  work  of  taking  an 
additional  bite  in  a  filmy  piece  of  wax,  and  without  taking  an 
impression  of  the  affected  tooth,  carrying  the  compound  impres- 
sion of  the  cavity,  and  of  the  surrounding  area  for  a  guide  to 
the  desired  correctness,  and  often  that  is  as  far  as  one  can  get 
to  the  correct  result,  ergo  the  desire  for  it. 

The  answer  is  made  that  while  all  of  these  steps  are  nec- 
essary, they  may  be  done  in  the  laboratory,  and  here  the  great 
mass  of  errors,  which  follow  the  use  of  such  materials  as  com- 
pounds, plaster,  amalgams,  variation  in  mass,  temperature,  and 
physical  structure  in  the  hands  of  a  laboratory  assistant,  who 


TAKIXC     I.MI'KKSSIOX    AND    .MAKIXi;    DIK 


141 


can  only  begin  working  upon  and  with  these  materials,  after 
the  errors  have  crept  in,  all  combine  to  give  a  result  not  looked 
for,  and  this  result  is  made  to  assume  a  semblance  to  the  one 


End  to  be  inserted 
in  slide 


Slide 


Fig.  149. — The  upper  figure  shows  a  piece  of  sheet  copper  33-  or  36-gauge, 
cut  as  illustrated.  The  lower  figure  shows  the  same  piece  of  copper  formed  into  a 
baii-1  and  locked  by  bending  surplus  back  upon  itself.  Note  at  aa  two  vertical  and 
two  horizontal  cuts  to  allow  the  improvised  band  to  be  forced  apart  in  order  to  ob- 
tain contact  with  adjacent  tenth. 


1'i^.  150. — Illustrating  a  handy  matrix  in  position  upon  a  molar. 

looked  for  by  using  the  burnishers  freely,  and  the  good  or  fairly 
good  margins  deceive  most  of  us. 


142  CAST  GOLD  AND  PORCELAIN  IXLAYS 

They  who  admit  their  incapability  to  make  an  accurate 
impression  of  a  cavity  in  inlay  wax,  have  never  familiarized 
themselves  with  its  physical  properties,  and  should  start  right 
there.  Let  them  study  the  wax,  its  physical  properties  under 
various  temperatures,  its  adaptability,  its  toughness,  etc.  "NYork 
it  carefully,  use  it  as  if  it  were  something  alive,  vibrant,  re- 
sponsive; for  it  has  in  it  all  the  things  that  give  life  and  re- 
sponsiveness, put  there  by  a  very  inspiration.  Then  let  these 
indirect  method  men  compare  their  results  of  the  time  at  hand 
and  the  time  past. 

The  advocates  of  the  indirect  method  obtain  an  impression 
of  the  cavity  for  which  they  expect  to  make  an  inlay,  and  they 
construct  a  die  upon  and  into  this  impression.  The  result  is  a 
partial  model  of  the  tooth  to  be  inlayed,  the  partial  model  being- 
made  of  amalgam  or  cement,  preferably  the  former. 

Some  proceed  to  form  the  wax  inlay  in  this  very  die,  which 
is  equivalent  to  making  a  complement  to  the  human  anatomy 
without  having  that  part  which  is  to  receive  the  complement 
before  you  in  its  entirety.  They  guess  at  bulk,  width,  length 
and  contour,  and  if  they  guess  correctly,  the  indirect  method 
is  a  success  and  they  proceed  to  give  it  to  those  whom  they 
designate  as  the  rank  and  file  of  their  profession. 

Now,  let  me  ask  this  of  the  rank  and  file  and  laymen: 
What  would  we  be  likely  to  think  of  a  man  who  tried  to  supply 
a  part  of  one  finger  of  a  hand  without  having  the  whole  of 
that  hand  before  him  all  through  the  operation?  AVould  we 
consider  him  correct?  Of  course  not,  because  he  will  have 
constructed  the  complemental  portion  without  due  reference  to 
the  whole;  without  having  at  his  disposal  a  comprehensive  view 
of  that  with  which  the  complemental  part  must  ever  interplay 
and  harmonize,  and  so  the  least  these  indirect  method  advocates 
can  do  is  to  have  before  them  a  complete  model  of  the  tooth. 
Some  of  them,  realizing  this,  obtain  a  wax  bite  (indefinite 
and  inaccurate),  and  so  to  speak,  plant  this  die  into  the  wax 
bite,  filling  in  the  rest  of  it  with  plaster.  Too  often,  almost 
always,  a  microscopic  shift  takes  place,  and  multimicroscopic 
errors  are  the  result. 

They  are  also  prone  to  harp  upon  the  subject  of  gold  and 
porcelain  inlays,  as  if  the  problems  were  one,  ignoring  pur- 


TAKING    IMlMiKSSIOX    AXI>    .MAKIXC    DIK  143 

y  or  otherwise,  the  fact  that  there  is  no  comparison  be- 
tween the  two,  except  that  both  act  as  fillings  or  inlays  for  a 
tooth. 

The  preparation  of  the  cavity  is  wholly  different;  the  phys- 
ical properties  of  the  material  are  wholly  different;  the  method 
of  construction  after  obtaining  impression  and  die  is  wholly 
different;  and  the  problems  or  obstacles  in  the  way  of  making 
porcelain  inlays  for  posterior  teeth  by  the  use  of  the  direct 
method,  are  many  times  greater  than  when  we  are  working 
in  gold. 

So  in  justice  to  themselves  and  the  art,  and  for  the  sake 
of  those  who  read  and  wish  to  learn,  they  should  be  more  care- 
fully accurate  in  their  statements,  and  less  confusing  to  the 
learner.  They  speak  of  the  advantage  of  the  indirect  method 
in  case  of  failure  at  the  time  of  casting,  ignoring  the  fact,  that 
they  (with  emphasis  on  the  ///<•//)  have  a  failure  as  the  result 
of  every  so-called  successful  casting. 

If  they  tested  the  machine  before  every  casting;  if  they 
were  always  careful  to  properly  mix  the  investment,  and  to 
always  duplicate  that  proper  mix;  if  they  took  the  time  to 
learn  how  to  properly  manipulate  the  wax;  if  they  were  careful 
to  note  the  boiling  point  of  the  gold  they  were  using  for  their 
casting,  which  is  considerably  different  from  the  fusing  point; 
assuming  that  all  their  materials  were  clean;  and  if  with  all 
the  foregoing,  they  used  the  direct  method,  they  would  not  need 
to  consider  the  possibility  of  failure. 

They  say  that  the  "Great  Taggart"  (and  they  are  care- 
ful to  say  "great"),  and  a  few  of  his  closest  followers  perhaps 
(note  the  perhaps)  can  do  the  work  by  the  direct  method,  and 
show  perfect  results;  thus  convicting  themselves  by  the  ad- 
mission that  they  have  not  followed  the  Great  Taggart.  Thus 
they  admit  the  perfect  results  of  Taggart  and  his  close  fol- 
lowers, but  they  Avant  the  rank  and  file  of  the  profession  to 
follow  them,  even  though  they  qualify  their  results  as  but  fairly 
accurate. 

If  Taggart  obtains  perfect  results  (which  they  admit),  and 
if  the  close  followers  of  Taggart  obtain  perfect  results,  and  if 
it  is  perfect  results  they  are  trying  to  obtain,  clearly  the  easiest 
and  surest  way  is  for  them  to  follow  the  directions  they  have 


144 


CAST  GOLD  AXI)  PORCELAIX  IXLAVS 


been  persistently  trying  to  confuse  and  obscure  for  the  rank 
and  file  of  the  profession. 

They  are  of  course  wasting  their  time,  and  the  time  of  those 
who  follow  their  indirect-niethod-ward  pointing  index  finger, 
and  it  may  not  please  them  much  to  contemplate  the  fact  that 
a  waste  of  time  is  a  waste  of  life. 

We  shall,  because  of  the  foregoing,  take  up  the  indirect 
method  of  making  a  wax  inlay  only  as  an  accessory  to  the  di- 


Fig.    151. 


Fig.    152. 


Figs,  151  and  152. — Hinged  trays  designed  and  constructed  by  the  author  for 
taking  correct  impressions  of  mesio-disto-occlusal  cavities  and  teeth  upon  which 
they  present. 


Fig.    153. — Disto-occlusal 
cavity  tray. 


Fig.   154. — Mesio-occlusal 
cavity  tray. 


Fig.    155. — Hinged    tray 
for  anterior  teeth. 


rect,  remembering  that  the  wax  must  be  given  its  final  shape 
and  fitting  in  the  tooth  cavity  itself. 

With  this  end  in  view,  the  hinged  and  perforated  trays 
here  illustrated,  were  constructed  in  their  various  sizes  and  in 
respect  to  the  tooth  forms  for  which  they  were  made;  they  are 
universal  in  application. 

There  are  ten  trays  for  the  upper  molars,  divided  as  fol- 
lows: 


TAKING    I.MI'KKSSIOX    AND    MAKl.XG    DIK 


ur, 


Two  right  upper  for  disto-occlusal  cavities. 

Two  right  upper  for  ine.-io-occliisal  cavities. 

One  riglit  upper  for  mesio-ilisto-occlusal  cavities. 

One  for  riglit  upper  bicuspids  for  disto-occlusal  cavities. 

One  for  riglit  upper  bicuspids  for  mesio-occlusal  cavities. 

One  for  riglit  upper  bicuspids  for  mesio-disto-occlusal  cav- 


ities. 


Fig.  156. — Hinged  tray  in  position.     Impression  of  m.  sio-disto-occlusal  cavity  partly 

completed. 


Fig.   157. — Hinged  tray  in  closed  position.     Completing  impression   of  mesio-disto- 
occlusal  cavity  and  tooth  upon  which  it  presents. 

Several  hinged  trays  in  three  sizes,  as  illustrated,  are  made 
for  use  upon  anterior  teeth,  when  occasion  presents  itself. 

These  trays  enumerated  for  the  right  upper  are  duplicated 
for  the  left  side  of  the  superior  maxilla,  except  that  the  trape- 
zoidal angles  are  changed  to  conform  with  the  requirements. 


146  CAST  GOLD  AND  POHCELA1N  INLAYS 

Only  half  of  the  number  of  trays  is  required  for  the  lower 
molars;  for  what  will  serve  as  a  disto-occlusal  tray  on  the  right 
side,  may  be  used  as  a  mesio-occlusal  on  the  left;  and  so  but  two 
mesio-occlusal  and  two  disto-occlusal,  and  one  mesio-disto-occlu- 
sal  tray  for  the  molars,  will  be  necessary. 

We  shall  need  one  mesio-occlusal  and  one  disto-occlusal  tray 
for  the  second  bicuspid  and  the  same  number  for  the  first  lower 
bicuspid  right  and  left.  Two  sizes  of  hinged  trays  for  each 
anterior  lower  tooth  may  be  made.  Eight  and  left  being  inter- 
changeable, only  six  trays  will  be  required  for  that  region. 

When  it  becomes  necessary  to  obtain  a  reliable  impression 
of  a  properly  prepared  cavity,  the  corresponding  tray  is  se- 
lected and  that  part  of  the  tray  which  is  contiguous  or  not 
hinged,  is  filled  with  a  small  amount  of  modeling  composition, 
softened  in  the  Bun  sen  burner.  Care  is  to  be  exercised  not  to 
burn  the  compound. 

The  two  hinged  and  lubricated  portions  of  the  tray  are  in- 
verted and  used  as  a  handle. 

The  compound-carrying  tray  is  now  carefully  brought  over 
the  tooth  and  centered;  then  with  a  direct  pressure  upward  or 
downward,  as  the  case  may  be,  the  cavity  is  filled,  and  that  part 
of  the  tooth  enveloped  in  the  soft  compound. 

Because  of  the  unyielding  tray,  the  impression  material  will 
be  forced  against  the  margins  of  the  cavity,  while  the  surplus 
will  be  expelled  buccally  and  lingual! y. 

The  two  hinged  wings  of  the  tray  previously  lubricated, 
are  quickly  closed  upon  the  buccal  and  lingual  sides  respectively, 
and  the  surplus  of  the  compound  is  held  against  the  tooth  under 
pressure. 

A  stream  of  cold  water,  directed  upon  the  tray,  will  chill 
the  compound. 

The  hinged  wing  upon  the  lingual  or  palatine  surface  is 
again  inverted,  the  surplus  compound  is  cut  away  with  a  sharp 
lance;  that  .surface  of  the  tooth  is  lubricated  with  some  white 
vaseline ;  a  small  piece  of  softened  impression  material  is  placed 
upon  the  inner  surface  of  the  wing  of  the  tray,  and  while  the 
latter  is  firmly  held  in  position,  the  former  is  closed  down  upon 
the  tooth  surface,  and  moderate  pressure  is  applied. 


TAKING    [MPRESSION    AND    MAKING    DIE 


147 


A  stream  of  cold  water  will  accelerate  tlie  hardening  of  that 
sin-face,  and  the  hinged  wing  upon  the  buccal  surface  is  sub- 
jected to  the  same  manipulation;  that  is,  it  is  inverted,  the  sur- 
plus cut  away,  the  tootli  surface  is  lubricated,  and  a  piece  of 
softened  impression  material  is  placed  upon  the  hinged  surface, 
when  it  is  again  reinverted  and  forced  to  place.  Again  a  stream 
of  cold  water  accelerates  hardening  of  the  compound. 

"Whatever  surplus  of  compound  may  show  gingivally,  may 
lie  removed  with  a  sharp  lance,  and  we  are  now  ready  to  obtain 
an  impression  of  the  surrounding  teeth,  a  model  from  which 
impression  may  give  us  our  cavity  and  its  rightful  environment. 

It  will  he  necessary  to  keep  the  saliva  ejector  in  the  pa- 


Fig.  158. 


Fig.  159. 


I-'i-.  158. — Complete  impression  of  tooth  and  cavityembedded  in  plaster  im- 
pression of  adjacent  teeth,  ready  for  the  packing  of  amalgam  die. 

Fig.  159. — Complete  impression  of  tooth  and  cavity,  removed  from  the  mouth. 

tient's  mouth,  in  order  to  carry  off  the  water  used  in  chilling 
the  compound. 

A  unilateral  tray  for  the  particular  side  of  the  mouth  is 
selected.  A  mix  of  plaster  of  Paris,  of  the  consistency  of  thick 
cream,  is  put  into  it,  and  the  tray,  plus  plaster,  is  quickly  car- 
ried to  the  side  of  the  mouth  and  carefully  forced  to  place. 

The  plaster  is  given  from  five  to, ten  minutes  to  set,  and 
a  spray  of  cold  air  is  directed  upon  it  while  it  is  setting,  when 
the  cup  is  removed  and  the  plaster  impression  carefully  broken 
away  from  the  tooth.  The  buccal  or  labial  portion  is  removed 
first,  by  placing  the  index  linger  of  one  hand  under  the  plaster 


148  CAST  GOLD  AND  PORCELAIN  INLAYS 

buccally,  and  keeping  the  index  finger  of  the  other  hand  upon 
the  morsal  surface  of  the  impression. 

The  patient  is  then  directed  to  open  the  mouth  much  wider, 
the  index  finger  under  the  buccal  side  of  the  impression  is  ro- 
tated towards  the  oral  cavity,  and  usually  no  difficulty  will  be 
experienced  in  the  removal  of  that  part  of  the  impression. 

An  upward  and  downward  pressure  upon  the  lingual  part 
of  the  impression  will  readily  dislodge  that  portion  of  it,  and 
so  all  parts  of  the  plaster  may  be  gathered  to  be  again  re- 
assembled in  the  cup  after  they  have  been  allowed  to  become 
moderately  dry. 

The  compound  carrying  tray  will  be  found  in  perfect  cc~- 
dition  upon  the  tooth  requiring  the  inlay. 

All  evidence  of  plaster  is  now  removed,  and  the  outer  or 
buccal  hinged  part  of  the  tray  is  again  inverted,  as  is  the  lingual 
or  palatine. 

Grasping  these,  two  hinges,  mesio-distally,  the  rest  of  the 
impression  will  come  out  and  may  be  brought  into  full  view 
outside  of  the  buccal  cavity. 

Again  the  two  hinges  are  put  back  into  their  respective 
positions,  and  we  shall  have  an  impression  of  the  entire  tooth, 
for  which  we  are  about  to  make  a  metallic  complement. 

Because  of  its  peculiar  position  within  the  plaster  impres- 
sion, the  tray  carrying  the  compound  impression  of  the  cavity 
will  be  immovably  fixed.  More  plaster  is  added  to  the  plaster 
impression  in  order  to  strengthen  its  walls;  all  the  plaster  is 
varnished,  and  we  are  ready  to  pack  the  amalgam  into  the  com- 
pound impression,  so  as  to  form  a  die,  reproducing  the  tooth 
that  requires  an  inlay. 

THE  MAKING  OF  THE  AMALGAM  DIE 

For  the  purpose  of  making  a  die,  either  a  silver  or  copper 
alloy  may  be  used. 

The  writer  has  been  able  to  obtain  much  more  clearly  de- 
fined margins  and  outlines  with  the  copper  alloy,  and  would, 
therefore,  commend  it  for  this  purpose. 

It  is  also  much  harder  and  not  nearly  so  likely  to  become 
subject  to  distorting  inaccuracy. 


TAKING    I.MI'IIKSSIOX    AND    MAKING    DIK  141) 

A  quantity  of  the  alloy,  varying  directly  as  the  size  of  the 
case,  is  placed  in  an  iron  spoon  and  carefully  heated  over  the 
Bunsen  flame  until  the  globules  of  mercury  appear  upon  the 
surface  of  the  small  copper  amalgam  briquettes. 

The  mercury-exuding  mass  is  now  thrown  into  a  "Wedgwood 
mortar,  and  thoroughly  macerated  under  pestle.  This  macera- 
tion is  kept  up  until  the  mass  seems  and  feels  smooth;  if  the  mix 
appears  thick,  more  mercury  must  lie  added,  so  that  a  thin  and 
readily  flowing  mass  may  he  obtained. 

The  Wedgwood  mortar  is  now  upset  upon  a  sheet  of 
manilla  paper,  and  with  a  stout,  broad  spatula  of  (ierman  silver, 
or  a  polished  steel  knife,  the  amalgam  is  spread  over  the 
largest  possible  area  of  the  paper  in  a  thin  film,  and  consid- 
erable pressure  is  used  to  make  certain  of  the  smoothness  of 
the  mass. 

When  this  has  been  attained,  the  amalgam  is  divided  into 
three  portions;  the  first  portion  should  be  large  enough  to  cover 
all  margins  as  well  as  the  seat  and  walls  of  the  cavity,  the 
second  portion,  about  twice  the  size  of  the  first,  and  the  third 
portion,  about  again  as  large  as  the  second. 

The  first  portion  is  now  put  into  a  piece  of  chamois  and 
twioted  up  into  a  ball.  A  part  of  the  mercury  is  expelled  by 
twisting  the  chamois,  but  under  no  circumstances  must  too  great 
a  pressure  be  applied,  as  that  would  make  the  mix  unfit  for  use 
at  this  stage. 

Pointed  instruments,  the  points  which  have  been  rounded, 
are  then  used  to  place  the  soft  amalgam  in  apposition  to 
every  margin,  wall  and  seat  of  the  cavity,  and  when  that 
has  beeen  accomplished,  smooth  flat  plugger  points  are  sub- 
stituted for  the  pointed  instruments,  and  the  amalgam  is  patted 
down  into  every  portion  and  up  to  every  margin  of  the  cavity 
impression. 

The  second  portion  of  amalgam  is  now  put  into  a  piece  of 
chamois,  and  the  chamois  containing  the  amalgam  is  twisted 
into  a  ball.  A  greater  portion  of  the  mercury  than  was  ex- 
pelled from  the  first  portion  of  amalgam,  is  now  expelled  from 
the  second  portion;  in  fact  the  latter  must  be  fairly  crisp  to  be 
fit  for  use. 


150 


CAST    GOLD    AX1)    POKCELAIX    JNJ.AYS 


Large  ball  and  egg  shaped  burnishers  are  used  to  place  this 
crisp  mass  over  and  into  the  amalgam  already  present  in  the 
impression.  It  will  be  noted  that  under  constantly  applied 
pressure,  the  newly  added  mass  will  take  up  the  excess  of  mer- 
cury in  the  mass  first  put  into  the  impression. 

Finally,  the  third  portion  of  amalgam  is  put  into  the 
chamois,  and  subjected  to  the  same  sort  of,  but  slightly  in- 
creased, pressure,  so  that  nearly  all  of  the  mercury  will  be 


Fig  160. — Model  presenting  a  view  of  amalgam  replica  of  tooth  requiring  restora- 
tion in  correct  relation  to  adjacent  teeth. 


Fig.   161. — Model  lubricated  with  mixture  of  castor  oil   and  glycerine. 

expelled  and  the  amalgam  becomes  quite  hard  and  but  just 
workable. 

With  large,  flat  packing  instruments  this  mass  is  now  grad- 
ually and  with  constantly  increasing  pressure  and  a  rocking 
motion,  put  into  and  onto  the  rest  of  the  amalgam. 

The  excess  of  mercury,  if  any  be  present,  is  now  removed 
by  burnishing  several  layers  of  tin  foil  over  the  flat  surface  of 
the  mass,  and  with  a  flat  chisel-end  instrument,  an  irregular 


TAKlXi;    JAIl'KKSSIOX    AND    AIAKIXC    DIE  151 

recess  equal  ill  depth  to  about  one-third  of  its  greatest  diameter, 
i>  sunk  into  the  mass  of  amalgam. 

Tlie  plaster  impression  carrying  the  hinged  tray  and  com- 
pound impression  which  contains  the  amalgam  which  lias  been 
introduced,  is  now  laid  aside  for  at  least  twelve  hours  to  give 
the  amalgam  an  opportunity  to  thoroughly  crystallize. 

The  next  step  should  be  the  immersion  of  the  amalgam- 
carrying  impression  into  water,  and  the  filling  in  of  the  rest 
of  the  impression  with  plaster  of  Paris,  when,  after  three-quar- 
ters of  an  hour  or  one  hour's  time  has  elapsed,  the  impression 
tray  is  freed  from  surrounding  plaster,  the  plaster  impression 
is  carefully  broken  ami  cut  away,  exposing  a  plaster  cast  carry- 
ing the  hinged  tray  and  compound.  The  cast  is  now  immersed 


t-U      , 


\ 


Fig.  162. — Occluded  models  of  case  requiring  restoration.  Note  in.  the  upper 
arch  the  amalgam  die  in  correct  relative  position  and  correct  occlusal  relation  to 
the  lower  model. 

in  water  at  a  temperature  of  135°  to  140°  F.  for  about  two 
minutes,  when  the  hinged  portions  of  the  tray  may  be  easily 
inverted  and  all  of  the  compound  impression  removed  from 
amalgam  tooth  and  cavity. 

"We  have  now  before  us  a  plaster  cast  securely  carrying 
a  complete  copper  amalgam  reproduction  of  the  tooth  requiring 
a  gold  inlay,  and  if  the  directions  prescribed  above  have  been 
studiously  followed,  the  cavity  in  which  the  wax  inlay  is  to  be 
formed  may  be  used  as  a  working  base  upon  which  the  pre- 
liminary carving  may  be  done. 

A  wax  bite  previously  secured  from  the  patient's  mouth 
is  now  mounted  upon  the  plaster  cast  that  carries  the  amalgam 


152  CAST  GOLD  AND  PORCELAIN  INLAYS 

tooth,  and  the  opposing  teetli  are  secured  by  filling  the  wax 
impression  on  the  reverse  side  of  the  wax  bite  with  a  mix  of 
plaster  of  Paris.  Both  upper  and  lower  may  now  be  mounted 
upon  an  adjustable  crown  articulator. 

AYhen  the  plaster  has  set,  the  articulator  carrying  the 
models  and  bites  is  immersed  in  hot  water,  and  the  wax  bite 
is  removed,  disclosing  the  amalgam  tooth  in  the  correct  relative 
occlusal  position  to  the  opposing  teeth. 

All  of  these  opposing  teetli  are  now  thoroughly  varnished 
with  a  thin  solution  of  sandarac,  and  this  is  allowed  to  harden. 

We  are  now  ready  to  make  our  wax  inlay  for  the  cavity. 

A  cone  of  inlay  wax  of  suitable  size  is  made  ready  for  use 
by  softening  it  in  hot  water  in  the  manner  described  under  the 
heading  of  making  and  carving  the  wax  inlay  by  the  direct 
method. 

The  softened  cone  of  wax  is  forced,  as  also  previously  de- 
scribed, into  the  lubricated  cavity,  in  this  instance,  of  the  amal- 
gam die  instead  of  the  tooth. 

While  the  wax  is  under  the  influence  of  the  finger  pressure, 
it  is  chilled  and  held  in  this  position  until  it  has  hardened,  then 
the  pressure  is  removed. 

All  we  are  concerned  with  at  this  stage  of  the  operation 
are  the  margins  and  seat  of  the  cavity,  and  the  approximation 
of  the  wax  to  this  seat  and  these  margins. 

With  the  proper  carvers  and  flat  burnishers,  right  and  left, 
all  but  the  occlusal  surface  of  the  wax  inlay  is  completed  at 
this  time. 

A  stream  of  cold  water  will  thoroughly  harden  the  wax  and 
a  jet  of  cold  air  will  dry  it.  A  ball  burnisher  is  now  heated  in 
the  Bunsen  flame  and  the  unfinished  occlusal  surface  is  sof- 
tened centrally;  that  is,  the  hot  instrument  is  allowed  to  enter 
the  wax  inlay  about  half  way  down  into  the  body  of  it,  care 
being  exercised  not  to  allow  the  heated  instrument  to  work 
through  the  wax  onto  the  seat  of  the  cavity,  or  up  to  the  mar- 
gins of  it. 

The  varnished  and  faintly  lubricated  opposing  teeth  are 
now  allowed  to  descend  or  ascend  upon  the  wax  in  order  to 
designate  the  landmarks  for  occlusal  carving. 

A  close  study  of  tooth  anatomy  should  be  made  by  the  in- 


TAKING    IMPRESSION    AND    MAKING    DIE  153 

lay  worker,  with  a  view  to  correct  reproduction  of  tooth  sur- 
faces in  general  and  the  occlusal  surface  in  particular;  the 
sulci  and  deep  fissures,  the  extreme  cusp,  elevation,  the  im- 
portant marginal  ridges  functioning  in  their  capacity  as  guard- 
ians of  the  interdental  tissues,  all  these  must  be  carefully 
reproduced  in  outline,  but  not  in  bulk;  in  other  words,  the 
important  tiling  to  bring  about  is  an  exact  reproduction  of  the 
part  of  the  tooth  which  is  lacking  to  make  it  a  perfect  dental 
organ,  but  the  complementel  portion  in  wax  must  be  as  much 
greater  in  all  surface  areas  as  the  amalgam  cavity  with  all  its 
surfaces,  seat,  margins  and  angles,  is  smaller  than  the  cavity 
in  the  tooth. 

This  variation  between  the  tooth  cavity  and  the  die  cavity 
in  size,  is  but  microscopic,  and  hardly  appreciable  to  the  eye, 
nevertheless,  it  is  sufficient  to  spell  failure  for  every  casting 
made  by  the  indirect  method  unless  this  means  is  taken  to  over- 
come the  defect. 

The  articulator  and  models  which  carry  the  inlay  are  put 
aside  until  the  patient  appears  for  the  next  sitting.  The  inlay 
is  removed  from  the  die,  mounted  on  the  cork  which  carries  a 
bankers'  pin,  the  pin  being  inserted  where  the  sprue  wire  is  to 
be  subsequently  attached. 

The  wax  inlay  thus  mounted  is  then  submerged  in  a  water 
bath,  the  temperature  of  the  water  being  about  120°  F.  After 
a  lapse  of  two  minutes  it  is  carefully  removed  from  the  pin  and 
placed  upon  a  glass  slab;  the  temporary  stopping  is  removed 
from  the  tooth;  the  cavity  is  Hushed  with  warm  water;  and  the 
\\ax  inlay  is  put  into  the  cavity,  a  firm  and  ever  increasing  pres- 
sure being  exerted  in  the  following  directions: 

If  the  cavity  be  a  disto-occlusal  one,  in  an  upper  tooth,  the 
pressure  must  be  directed  upwards  and  forward. 

In  mesio-occlusal  cavities,  the  pressure  must  be  upward  and 
backward. 

In  the  upper  mesio-disto-occlusal  cavities,  the  pressure 
must  be  upward,  but  the  points  against  which  the  pressure  is 
exerted  must  be  the  marginal  ridges  of  the  wax  inlay.  This 
can  be  accomplished  by  making  a  V-shaped  cushion  of  the  thumb 
and  index  finger,  or  the  thumb  and  middle  finger  of  the  right 
hand. 


15-4  CAST  GOLD  AND  PORCELAIN  INLAYS 

If  the  cavity  is  a  disto-occlusal  one  in  a  lower  tootli,  the 
pressure  exerted  upon  the  wax  inlay  must  be  directed  down- 
ward and  forward.  In  lower  mesio-occlusal  cavities,  the  pres- 
sure must  be  downward  and  backward,  and  in  lower  mesio- 
disto-occlusal  cavities,  the  pressure  must  be  directed  downward, 
and  it  must  be  exercised  against  and  upon  the  marginal  ridges 
of  the  inlay. 

When  the  wax  thus  slightly  warmed  has  been  placed  in  the 
cavity,  and  the  carefully  exerted  ever-increasing  force  is  applied, 
the  inlay  will  begin  to  yield  under  this  pressure  and  seat  itself 
against  every  part  and  margin  of  this  cavity. 

Presently  the  wax  will  cease  yielding,  but  the  pressure  must 
be  maintained,  and  a  stream  of  cold  water  is  directed  upon  and 
around  it  to  thoroughly  harden  it. 

With  the  various  carvers  and  right  and  left  burnishers, 
all  margins  are  now  carefully  gone  over  and  the  occlusion  made 
perfect. 

The  interdental  and  gingival  portions  of  the  wax  inlay  are 
carefully  burnished  with  the  flat  right  and  left  blade  burnish- 
ers, the  contact  area  between  the  wax  inlay  and  the  next  tooth, 
if  any  be  present,  is  carefully  looked  to,  and  the  wax  is  pol- 
ished with  a  pellet  of  cotton  sparingly  moistened  in  oil  of 
cajeput. 

An  explorer  is  inserted  into  the  distal  part  of  the  inlay 
and  it  is  carefully  removed  from  the  cavity  and  the  mouth, 
placed  upon  the  palm  of  the  operator's  left  hand,  so  that  the 
disto-proximal  or  mesio-proximal  portion  of  it  be  uppermost. 

The  sprue  wire  is  heated  in  the  flame  of  the  Bunsen  burner 
or  alcohol  lamp,  and  inserted  beyond  the  depth  of  the  ring  upon 
it,  midway  between  the  buccal  and  lingual  extremities  of  the 
inlay.  Once  the  sprue  wire  has  in  its  heated  condition  entered 
the  inlay,  a  gentle  stream  of  cold  water  is  played  upon  the 
extreme  end  of  the  sprue  wire,  or  better,  upon  the  fingers  that 
hold  it  until  the  wire  is  cold.  This  must,  of  course,  be  done  by 
the  assistant;  if  none  be  present,  the  patient's  help  may  be  en- 
listed for  the  purpose  or  the  tweezers  may  be  used. 

A  soft  rubber  sponge  placed  at  the  bottom  of  a  glass  of 
water,  serves  to  efficiently  support  the  wax  inlay-carrying  sprue 
until  the  cotton  rolls  are  applied  on  either  side  of  the  patient's 


TAKIXC     IMI'UKSSIOX    AX!)    MAKIXC    DIE  155 

tooth;  the  saliva  ejector  is  placed  in  position  the  cavity  thor- 
oughly dried  out  and  filled  up  with  temporary  stopping;  the 
patient  is  dismissed.  AYlien  we  are  ready  to  embed  or  invest 
the  inlay  in  the  refractory  compound,  it  is  removed  from  the 
watery  sponge  bed,  by  grasping  the  sprue  wire  carefully  with  a 
pair  of  tweezers.  The  wax  inlay  is  dried  with  a  gentle  jet  of 
cold  air  and  the  sprue  wire,  plus  inlay,  is  mounted  upon  the 
crucible  former.  Such  pits  or  grooves  as  may  seem  necessary 
to  the  operator  may  now  be  carved  upon  the  wax  with  a  small 
sharp  lance,  remembering  that  it  is  easier  to  do  this  in  the  wax 
than  in  the  metallic  duplicate  of  it. 

It  may  as  well  be  said  here  as  anywhere,  that  not  much, 
if  any,  dependence  should  be  placed  upon  these  grooves  or  pits 
as  retaining  factors  between  an  inlay  cavity  and  an  inlay,  and 
personally  I  resort  rarely,  if  at  all,  to  this  practice,  for  reasons 
to  be  touched  upon  later. 

Now,  before  proceeding  to  the  next  step  in  the  construc- 
tion of  a  cast  gold  inlay,  may  I  be  permitted  to  ask  the  advo- 
cates of  the  indirect  method,  to  again  read  what  has  been  said 
in  regard  to  directions  for  taking  the  impression,  making  the 
die,  and  carving  the  wax  inlay  by  means  of  this  method.  In 
full  justice  to  the  patient,  to  the  art,  and  to  themselves,  let  them 
read  and  let  them  construct  an  inlay  as  they  read,  and  let  them 
implicitly  follow  directions,  and  then  let  them  construct  an 
inlay  in  accordance  with  their  usual  procedure;  let  them  then 
compare  both  results  by  putting  the  finished  products  into  the 
tooth  cavity. 

In  the  first  instance  they  will  have  a  complemental  product 
which  will  interplay  with  all  the  cavo-surfaces  of  the  tooth  with 
a  grateful,  frictional,  and  supporting  contact,  and  as  to  what 
they  will  find  in  the  second  one,  I  am  ready  enough  to  leave  to 
their  judgment,  providing  they  have  examined  the  first.  Up 
to  the  present  time  I  have  found  no  other  means  of  making  an 
accurate  inlay  by  the  indirect  method,  except  the  one  minutely 
described,  and  when  the  advocates  of  the  so-called  indirect 
method  shall  have  read  and  followed  these  directions,  they  will 
admit  readily  enough  that  the  method,  if  carried  out  as  to  each 
detail,  will  bring  desirable  results,  but  they  will  also  add  that 
the  time  spent  in  obtaining  the  results  is  far  too  great. 


156  CAST  GOLD  AND  PORCELAIN  INLAYS 

Surely,  if  they  are  seeking  better  results  by  means  of  an 
indirect  method,  and  if  their  indirect  method  is  not  quite  ef- 
ficient, and  if  all  these  steps  I  have  described  and  all  these 
directions  I  have  given  do  lead  to  a  more  perfect  result,  that 
is  the  indirect  method  which  they  should  adopt. 

On  the  other  hand,  there  is  nothing  which  they  can  ac- 
complish, no  result  which  they  will  produce,  by  following  every 
detail  of  those  directions  most  studiously  and  indulging  in  the 
expenditure  of  all  the  time  necessary,  which  may  not  be  dupli- 
cated perfectly  in  every  detail,  in  a  great  deal  shorter  period  of 
time,  if  they  follow  the  directions  given  for  the  construction  of 
the  wax  inlay,  in  accordance  with  the  rules  originally  laid  down 
by  him  whom  they  all  call  great,  who  is  responsible  for  the 
very  existence  of  the  cast  gold  inlay;  in  other  words,  if  they 
follow  the  direct  method. 

The  cast  gold  inlay  made  by  the  indirect  method,  which  is 
here  described  in  detail,  compares  very  favorably  with  those 
made  by  the  direct  method;  in  fact,  it  is  impossible  to  differ- 
entiate  them  at  all. 

It  must  be  remembered  that  here  the  indirect  method  was 
used  only  as  an  accessory  to  the  direct,  and  that  the  time  con- 
sumed was  far  greater  than  if  the  direct  method  alone  had  been 
employed.  Also,  no  time  had  been  saved  to  the  patient;  in  fact, 
another  visit  was  the  result. 

We  are  forced  to  the  conclusion  that  the  direct  method  is 
the  rational  one,  and  that  they  who  desire  to  follow  a  correct 
indirect  method,  and  who  wish  to  eliminate  guess  work,  must 
give  that  which  all  indirect  methods  of  doing  anything  entail, 
namely,  they  must  give  up  more  time. 

The  one  advantage  the  indirect  method  may  claim  is  that 
it  would  be  possible  to  break  up  one  protracted  sitting  of  a 
patient  into  two  shorter  sittings. 

In  feeble,  convalescent,  or  exceedingly  nervous  individ- 
uals, this  method  works  to  better  advantage,  and  those  are  the 
conditions  it  was  perfected  for  and  is  used  in,  but  it  cost  more 
time  and  effort  to  produce  an  acceptable  result  in  this  way,  than 
it  would  to  obtain  the  same  result  with  the  direct  method. 


TAKING    IMPRESS  10 X    AND    MAKING    DIE  1  f)7 

SUMMARY  FOR  CHAPTER   IX 

Taking  an  Impression  of  the  Cavity  and  Making  a  Die  for  Procedure  by  the 

Indirect  Method 

1-  Give   the    reasons   why   in   the   writer's   opinion   this    method   is   unscientific. 

"2.  When  may  it  be  used  in  conjunction  with  the  direct  method? 

3.  Describe   the   trays   devised   for  use   with   the   indirect    method   and   the 

technic  of  their  application. 

The  Making  of  the  Amalgam  Die 

1.  Why  is  a  copper  alloy  preferable? 

2.  Describe   the  method   of  preparing  the   copper  alloy  for  the   packing  of 
the  compound. 

3.  Describe  the  method  of  making  the  wax  pattern  from  the  metal  die. 

4.  Describe  the  technic  of  transferring  tho  wax  pattern  from  the  die  to  the 
cavity  and  the  conformation  of  the  pattern  to  the  tooth. 

5.  Describe  the  detail  of  inserting  the  sprue  wire  into  the  wax  pattern  and 
its   disposal  before  investing. 


CHAPTER  X 
THE  INVESTMENT,  OR  REFRACTORY,  COMPOUND 

As  the  heading  of  the  chapter  implies,  the  investment  is 
the  mass  into  which  the  wax  inlay  is  embedded,  to  form  a  mold 
into  which,  upon  volatilization  of  the  wax,  the  metal  may  he 
forced  to  assume  a  definite  shape. 

Because  the  metal  must  be  forced  into  this  mold  in  a  liq- 
uefied condition,  and  because  it  requires  a  great  deal  of  heat  in 
order  to  liquefy  the  metals  used  for  inlays,  the  compounds  or 
substances  that  make  up  the  investment  must  be  refractory, 
that  is,  they  must  in  themselves  and  in  combination  with  each 
other  possess  the  property  of  resisting  disintegration  under  heat 
of  considerable  degree. 

AVliile  this  is  an  important  property  of  the  compound,  it 
is  no  more  so  than  the  properties  enumerated  below,  and  unless 
a  compound  can  meet  the  requirements  stated,  it  is  unfit  to  be 
used  for  the  making  of  molds  into  which  inlays  are  to  be  cast. 

Since  these  castings  are  to  be  made  under  pressure  of  one 
kind  or  another,  the  compound  used  should  be  strong  enough  to 
resist  such  pressure;  and  since  such  pressure  varies,  the  com- 
pound should  possess  a  safety  margin  of  pressure  resistance  at 
least  double  that  of  the  amount  required. 

Because  of  accuracy  required  in  the  reproduction  of  fine 
lines,  angles  and  margins,  the  compound  must  be  one  that  will 
crystallize  in  such  minute  crystal  formation  as  will  enable  these 
crystals  to  move  into  every  line  and  depression  of  the  pattern. 

At  the  same  time  the  crystals  must  be  of  such  shape  that 
the  hardened  or  set  mass  will  present  a  structure  sufficiently 
porous  to  carry  oft'  any  gases  formed  in  the  mold  during  the 
process  of  volatilization,  and  during  the  process  of  the  introduc- 
tion of  the  metal. 

Smoothness  of  the  mass  must  also  be  considered,  and  since 
that  is  a  quality  that  is  usually  obtained  at  the  expense  of 

158 


IXYKST.MKXT,    Oil    IIEFIIACTOIIY,    C<  >.\I  l'<  M"  X  1)  159 

porosity,  it  presented  at  first  an  almost  insurmountable  obstacle 
in  the  chain  of  steps  essential  to  success  in  the  art. 

Finally,  the  working  qualities  of  the  mass,  when  mixed  for 
use,  must  be  such  as  to  give  the  user  a  sufficient  amount  of  time 
to  carefully  invest  his  pattern,  which  means  that  when  properly 
mixed,  the  mass  presents  the  appearance  of  a  cream,  smooth  and 
easy  (lowing,  and  free  from  air  cells. 

A  great  many  of  the  refractory  agents  suggested  themselves 
to  the  investigators,  many  of  whom  are  even  now  engaged  in 
the  problem  of  trying  to  compound  a  more  perfect  investment 
material. 

All  of  them  have  been  compelled  to  retain  as  a  portion  of 
the  mass,  a  considerable  quantity  of  plaster  of  Paris  as  a  bind- 
ing force  for  the  whole. 

Plaster  of  Paris  is  manufactured  from  the  mineral  called 
gypsum,  which  is  comparatively  soft. 

Chemically,  it  is  a  hydrated  sulphate  of  lime,  CaS04  +  2H20. 
Its  specific  gravity  is  2.31  and  its  hardness  is  from  1.5-2  of  the 
mineral  scale. 

The  three  most  frequent  varieties  of  it  are  known  as  ala- 
baster, a  marble-like  mass  usually  faintly  tinted  and  translu- 
cent; a  selenate,  which  is  crystallized  and  transparent;  and  a 
variety  known  as  satin  spar,  which  has  a  pearly  opalescence 
due  perhaps  to  its  fibrous  foundation. 

( lypsum  has  a  wide  geologic  distribution,  the  extensive  beds 
of  the  common  variety  generally  occurring  as  irregular  concre- 
tions in  nodular  masses,  and  it  is  frequently  found  associated 
with  rock  salt.  A  mineral  known  as  anhydrite  or  anhydrous 
sulphate  of  lime,  found  near  the  Harz  Mountains  and  in  parts 
of  Nova  Scotia,  may  be  converted  into  gypsum  by  the  addition 
of  water. 

Gypsum  contains  21  per  cent  of  water,  which  can  be  driven 
off  by  heat.  It  is  burned  in  kilns  at  a  temperature  of  250°  F., 
then  ground  to  a  fine  powder,  and  as  such,  it  is  known  as  plaster 
of  Paris.  This  recombines  with  water,  evolves  heat,  and  crys- 
tallizes at  the  expiration  of  a  few  minutes. 

If,  in  the  burning  of  the  gypsum,  the  temperature  be  raised 
to  or  about  480°  F.,  and  then  ground  into  a  fine  powder,  it  will 
be  found  to  have  lost  its  power  of  dehydration  and  in  this 


160  CAST  GOLD  AND  POKCKLAIX  INLAYS 

state,  it  will  not  set  when  mixed  with  water  and  it  is  said  to  be 
dead  burnt. 

At  ordinary  temperature,  gypsum  and  plaster  of  Paris  are 
soluble  in  water,  in  the  proportion  of  two  and  a  fraction  of 
the  solids  to  1000  parts  of  water,  and  its  point  of  maximum  solu- 
bility is  about  95°  F. 

Plaster  of  Paris  shrinks  upon  being  heated,  and  in  itself 
is  therefore  an  unreliable  mass  for  molds  which  are  to  receive 
high  fusing  metals,  or  alloys  in  a  liquefied  state. 

Some  of  the  other  materials  used  as  refractories  are  the 
compounds  of  silica,  alumina,  magnesia,  and  calcium. 

Of  these  the  silica  is  the  most  important,  for  although 
utterly  lacking  in  tensile  strength,  it  has  the  property  of  ex- 
panding when  heated. 

SILICON 

Silicon  is  one  of  the  nonmetallic  elements:  symbol  Si; 
atomic  weight  28.3(0-16);  sp.  gr.  of  crystalline  form,  2.49.  It 
may  be  obtained  in  two  different  forms :  viz.,  the  amorphous 
and  the  crystalline. 

Amorphous  silicon  presents  the  appearance  of  a  dull  brown 
powder,  prepared  by  heating  silicon  with  aluminum.  It  is 
nonconductor  of  electricity,  and  when  heated  in  air  or  oxygen, 
its  external  surface  burns  brilliantly,  and  is  converted  into 
silica,  which  fuses  from  the  extreme  heat  and  forms  a  coating- 
over  the  unburned  silicon.  Deville  obtained  crystallized  silicon 
in  regular  six-sided  pyramids  of  a  dark  steel-gray  color.  A 
somewhat  impure  form  is  prepared  by  the  Carborundum  Com- 
pany of  Niagara  Falls  by  heating  coke  and  sand  in  an  electric 
furnace. 

Silica,  or  silicon  dioxide,  exists  both  in  the  crystalline  and 
in  the  amorphous  form.  The  best  examples  of  the  crystalline 
form  are  rock  crystal,  quartz,  chalcedony,  flint,  sandstone  and 
quartzose  sand.  Silicon  in  this  form  has  a  specific  gravity  of 
about  2.9,  and  is  only  attacked  with  difficulty  by  potash  or 
hydrofluoric  acid.  The  amorphous  form  exists  naturally  in  opal, 
and  is  obtained  artificially  as  gelatinous  silica,  etc.  It  differs 
from  the  former  in  its  specific  gravity,  being  about  2.2,  and  in 


IXYKSTMKXT,    OR    REFRACTORY,    ('OMPOCXJ)  161 

its  being  rapidly  dissolved  by  potasli  and  by  hydrofluoric  acid. 

Pure  silica  (a*  if  occur*  in  roc]:  cri/stal,  for  c.ramplc)  is 
pcrfcctlii  transparent  and  colorless,  and  is  xnffic'n-ntlij  linrd  to 
scratcl  (/lass.  Tlic  }>eal  of  Hi,-  o.ri/lnidrof/en  bloirplpe  is  re- 
quired for  its-  fusion,  irJicn  it  melts  into  a  transparent  (/lass, 
capable  of  bcinf/  drawn  out  Into  electric  thread*.  Silicic  acid 
may  he  precipitated  by  addition  of  hydrochloric  acid  to  a  so- 
lution of  sodium  silicate.  By  exposing-  the  silicic  acid  to  red 
heat,  pure  amorphous  silica  may  be  obtained.  The  solubility 
of  hydrated  silicic  acid  in  water  accounts  for  the  presence  of 
silicic  acid  in  mineral  springs,  and  in  the  geysers  of  Iceland, 
as  well  as  for  its  gradual  separation  from  those  waters  in  the 
form  of  petrifactions.  Silicates  are  salts  of  silicic  acid  (of 
which  several  hydrated  forms  have  been  obtained)  or  combina- 
tions of  silicon  dioxide  and  metallic  basic  oxides.  They  may 
he  divided  into  five  classes:  (1)  Orthosilicates,  derived  from 
H,Si04;  (2)  Metasilicates,  from  H2SiO:!;  (3)  Disilicates,  from 
HoSioO-, ;  (4)  Trisilicates,  from  H2Si303;  and  (5)  Basic  silicates. 
They  occur  abundantly  in  nature,  all  the  forms  of  clay,  felspar, 
mica,  hornblende,  auaitc,  serpentine,  etc.,  being  compounds  of 
this  description.  Most  of  the  silicates  are  fusible,  the  basic 
silicates  fusing  more  rapidly  than  those  of  which  are  either  neu- 
tral or  contain  an  excess  of  acid.  Excepting  the  silicates  of  the 
alkalies,  there  are  no  silicates  which  are  soluble  in  water. 

Silicon  is  largely  employed  in  the  manufacture  of  glass, 
china  and  porcelain.  The  use  of  silica  in  giving  firmness  and 
rifiiditit  to  rarions  parts  of  the  animal  organs  is  exemplified  in 
its  free  occurrence  in  the  quill  part  of  tlie  feather  of  birds,  in 
flic  shields  of  certain  infusoria,  and  in  the  spicnla  occurring  in 
sponaes,  while  its  similar  use  in  the  vegetable  kingdom  is  seen 
in  its  more  or  less  abundant  presence  in  the  stalks  of  the  (/rasses,. 
more  particularly  in  the  cereals  and  in  the  bamboo. 

Silicon  combines  with  >everal  other  elements  besides  oxy- 
gen, the  most  important  compounds  being  silicofluoric  acid 
(fLSiF4)  and  silicon  carbide,  or  carborundum  (SiC),  which  is 
very  hard  and  used  for  grinding  and  polishing.  Silicon  fluoride 
(SiF4)  is  a  colorless  gas  usually  prepared  by  heating  together 
calcium  fluoride  and  strong  sulphuric  acid.  It  is  decomposed 
into  water  silicic  acid,  and  silicofluoric  acid. 


162  CAST  GOLD  AND  PORCELAIN  INLAYS 

CALCIUM 

Calcium  (symbol  Ca;  atomic  weight  40.09)  is  the  metal 
present  in  chalk,  and  other  compounds  of  lime.  It  may  be 
obtained  by  passing  a  current  of  electricity  through  fused  chlo- 
ride of  calcium.  It  is  a  yellowish  white  metal,  intermediate  be- 
tween lead  and  gold  in  hardness.  At  ordinary  temperatures, 
it  rapidly  decomposes  in  water,  forming  lime,  CaC,  while  hy- 
drogen escapes.  It  forms  an  oxide,  lime,  having  the  composi- 
tion of  forty  parts  of  calcium  and  x'uieen  parts  of  o.rijgeu. 
Sulphate  of  calcium,  CaS04,  is  the  chief  constituent  of  gypsum. 
It  is  present  in  most  drinking  waters,  rendering  them  perma- 
nently hard.  Temporary  hardness,  due  to  the  presence  of  car- 
bonate of  calcium  or  chalk,  is  removable  by  boiling. 

MAGNESIUM 

Magnesium  (symbol  Mg;  atomic  weight  24.32)  is  a  metal 
which  is  very  widely  distributed  over  the  globe.  It  is  present 
in  magnesite,  magnesium  carbonate,  dolomite,  carbonate  of  lime 
and  magnesia,  asbestos,  silicate  of  lime  and  magnesia,  meer- 
schaum-silicate of  magnesia,  kainite,  and  in  other  minerals.  It 
exists  in  mineral  waters  and  the  sea  as  sulphate  and  chloride, 
the  sulphate  being  known  as  epsom  salts.  The  metal  is  made  by 
fusing  together  the  chlorides  of  potassium  and  magnesium  and 
fluor  spar,  and  adding  metallic  sodium  with  great  care.  The 
crude  metal  is  finally  distilled  and  pressed  in  a  semifluid  state 
into  ribbon  or  wire. 

Magnesium  has  a  silver  white  color,  which  is  tarnished  by 
moist  air.  It  is  a  very  light  metal,  its  specific  gravity  being- 
only  1.75.  It  is  readily  volatile,  and,  when  lighted,  burns  in 
air  with  an  intensely  brilliant  light,  rich  in  chemical  rays.  On 
this  account  it  was,  until  superseded  by  the  electric  light,  much 
used  in  photography,  while  in  signaling  and  pyrotechny  it  plays 
an  important  part. 

When  magnesium  burns  in  air,  it  forms  a  white  ash  con- 
sisting of  the  oxide,  magnesia,  MgO  (which  may  also  be  pre- 
pared by  heating  the  carbonate).  The  carbonate,  MgC03,  is 
found  in  nature,  but  for  medical  purposes  it  is  prepared  by 


IXYKST.MKXT,    Ol!    JIKni.UTOltY,    CO.M  I'Ol '  X  I)  !(>.'> 

precipitating  a  soluble  magnesium  salt  with  carbonate  of  soda. 
Although  insoluble  in  water,  this  substance  readily  dis- 
solves in  water  containing  carbonic  acid,  and  this  solution  is 
known  as  fluid  magnesia.  The  sulphate,  MgS04  +  7H20,  or  ep- 
som  salts  (an  infusion  of  which  witli  senna  is  known  as  black 
draught),  occurs  in  nature,  anil  is  well  known  as  a  domestic 
remedy.  Citrate  of  magnesia  is  the  popular  name  for  a  granu- 
lar, effervescing  aperient.  It  consists  of  a  mixture  of  bicar- 
bonate of  soda,  tartaric  and  citric  acids,  sugar,  and  a  small  trace 
of  epsom  salts. 

ALUMINA 

Alumina  is  the  most  abundant  of  the  earths;  it  is  the  oxide 
of  metal  aluminum,  the  formula  being  A12O3.  It  occurs  in  na- 
ture abundantly  in  combination  with  silica,  associated  with 
other  bases.  The  most  familiar  of  its  native  compounds  is 
felspar,  a  silicate  of  alumina  and  potash,  K20,  A12O8,  GSiO,. 
Certain  varieties  of  this,  by  exposure  to  the  atmosphere,  be- 
come completely  disintegrated;  passing  from  the  state  of  hard, 
solid  rock,  such  as  we  are  accustomed  to  see  in  building  granite, 
into  soft  crumbling  earthy  masses.  ( 'laij  consists  of  a  silica  and 
alumina  in  a  state  of  cl/cmical  combination.  It  never  is  pure 
alumina,  but  tl/e  quantitu  of  silica  united  to  the  latter  is  rari- 
able.  When  it  is  pure,  clay  is  quite  irltite,  but  more  frequently 
da i/  is  red.  otrina  to  the  presence  of  oxide  of  iron;  or  black, 
from  the  diffusion  tJirouah  it  of  vegetable  matter. 

From  alum,  alumina  is  prepared  by  adding  to  a  solution 
of  the  former,  water  of  ammonia,  as  long  as  it  occasions  a  pre- 
cipitate. AVhen  alumina  is  precipitated  from  a  solution  con- 
taining coloring  matter,  such  as  logwood,  etc.,  it  carries  down 
the  color  chemically  united  to  the  flocculent  precipitate;  in  this 
way  are  formed  the  colored  earths  called  lakes.  Alumina  in 
the  state  of  the  precipitate,  after  being  gently  dried,  is  readily 
soluble  in  acids  and  in  alkalies;  but  if  strongly  heated  at  a  cer- 
tain temperature,  it  presents  an  appearance  of  sudden  incan- 
descence; it  loses  the  associated  water,  contracts,  greatly  in 
bulk,  and  now  forms  a  tchite  soft  poirder,  not  at  all  gritty,  and 
with  difficulty  soluble  in  alkalies  and  acids.  Alumina,  as  gen- 
erally prepared,  whether  hydrated  or  anhydrous,  is  soluble  in 


CAST  GOLD  AND  PORCELAIX  INLAYS 

water,  possesses  no  taste,  and  does  not  alter  coloring  matters, 
but  it  lias  also  been  obtained  in  an  allotropic  hydrated  form, 
which,  in  the  presence  of  a  very  small  proportion  of  acetic  acid, 
is  largely  soluble  in  water,  from  which  a  minute  trace  of  snl- 
furic  acid  precipitates  it.  In  the  anhydrous  state  it  absorbs 
water  with  great  readiness  without  combining  with  it,  so  that 
it  adheres  to  the  tongue,  and  if  left  parches  it.  Clay  retain* 
this  property;  the  ends  of  tobacco  pipes  are  often  glazed  to 
prevent  adhesion  to  the  lips  or  tongue.  Alumina  is  not  fusible 
by  a  forge  or  furnace  heat,  but  it  melts  before  the  oxyKydtogen 
blowpipe  into  a  clear  globule,  possessing  great  hardness.  The 
more  coarsely  crystallized  specimens  form  the  emery  which  is 
used  for  polishing;  the  transparent  crystals  when  of  a  blue 
color,  owing  to  a  trace  of  metallic  oxide,  constitute  the  precious 
gem,  the  sapphire;  and  when  red,  the  ruby.  Alumina,  in  com- 
mon with  other  sesquioxides,  is  a  feeble  base. 

Like  alumina,  magnesium  and  calcium  are  unreliable  as  to 
constancy  of  bulk  upon  accession  of  heat,  and  so  were,  in  and 
by  themselves,  not  to  be  favored  as  constituents  of  any  mass 
to  be  used  for  molds  into  which  too  high-fusing  metals  were  to 
be  cast. 

The  apparent  impossibility  of  obtaining  all  these  refrac- 
tories in  a  pure  state  was  another  trying  problem  which  had  to 
be  solved  before  a  really  worthy  compound  could  be  produced. 

It  may  be  safely  asserted  that  all  the  investment  com- 
pounds at  present  offered  to  the  profession,  contain  one  or 
more  of  the  refractories  enumerated,  in  a  varying  combination 
with  plaster  of  Paris;  some  are  carefully  determined  correct 
relative  combinations;  some  are  haphazardly  thrown  together, 
mixtures  of  questionable  value,  the  sale  of  which  should  be  pro- 
hibited. 

So  much  of  the  success  in  casting  depends  upon  a  depend- 
able mold  that  only  the  very  best  at  present  to  be  obtained 
should  be  considered. 

For  a  long  time  I  used  a  compound  which  I  mixed  for  my- 
self in  accordance  with  the  following  formula : 

Plaster  of  Paris    %4 

Silox    l%4 

Graphite   flakes    (small)     %4— 2%4 — 1. 


i.\\  KST.MI-:XT,  on  i;i-:n;.\(Toi;y.  CO.M  i-m MI  lu'5 

The  process  of  making  this  compound  was  attended  with 
so  much  inconvenience  and  the  results  (because  of  the  unrelia- 
bility of  the  products)  were  so  inconstant,  that  the  various  com- 
pounds on  the  market  were  carefully  tried  out,  an<l  the  Tag- 
gart  investment  tinally  decided  upon. 

Such  great  care  is  used  in  the  manufacture  of  this  invest- 
ment that  taking  the  variation  in  temperature  into  considera- 
tion and  allowing  for  these  thermal  changes,  constant  results 
may  invariably  be  attained. 

I  have  been  unable  to  definitely  ascertain  just  what  the 
proportion  of  the  various  ingredients  which  enter  into  the  mak- 
ing of  this  compound  are,  but  the  product  has,  after  a  period 
of  three  years,  proved  so  satisfactory  and  so  thoroughly  reli- 
able in  its  working  qualities,  that  I  unhesitatingly  give  it  first 
place  in  the  list  of  those  at  present  urged  upon  the  profession. 

Some  common  sense  precautions  must  be  taken  in  using  this 
refractory  compound,  which,  in  order  to  be  employed  for  molds, 
must  be  mixed  with  water. 

The  powder  must  be  kept  in  a  closed  receptacle  in  a  dry 
place,  not  exposed  to  rapid  changes  of  temperature;  it  must  be 
mixed  with  water  neither  too  cold  nor  too  warm. 

AVater  at  room  temperature,  about  75°  F.,  will  do  well 
during  the  cold  weather.  This  may  be  had  by  allowing  a 
pitcheri'ul  of  the  water  drawn  from  the  faucet,  to  stand  in  the 
room  all  day,  thus  modifying  its  temperature  with  that  of  the 
room.  During  the  hot  months,  cold  water  may  be  added  to  that 
obtained  from  the  faucet  and  the  desired  results  reached  in 
this  way. 

It  must  be  remembered  that  all  these  investments  are  hy- 
groscopic; they  have  a  great  affinity  for  moisture,  and  the  cans 
must,  therefore,  be  kept  tightly  closed.  For  the  same  reason  it 
will  require  less  water  for  a  perfect  mix  during  very  humid 
weather  than  during  dry  weather. 

The  quota  of  investment  powder  and  water  having  been 
made  constant  by  Taggart,  the  variation  of  temperature  and 
humidity  may  be  taken  care  of  by  the  addition  of  a  few  min- 
ims of  water  during  excessively  dry  weather,  and  by  the 
reduction  of  the  quantity  of  water  in  the  same  proportion  dur- 
ing the  extremely  humid  weather.  In  no  case  is  amount  of 


166  CAST  GOLD  AND  PORCELAIN  INLAYS 

variation  greater  than  20  drops,  running  from  that  down  to  5. 

The  small  quantity  of  graphite  flakes  used  in  the  investment 
enables  us  to  obtain  a  smooth  mass  without  the  loss  of  too  much 
porosity  of  the  mold. 

The  things  absolutely  necessary  for  a  proper  mix  of  invest- 
ment are  these: 

The  investment,  powder  and  water,  a  small  scale  in  which 
the  quantity  of  each  may  be  definitely  determined,  subject  to 
variation  with  atmospheric  changes,  a  large  rubber  cup  kept 
scrupulously  clean,  and  used  for  this  purpose  only,  and  a  broad, 
flexible,  hard  rubber  spatula. 

The  large  cup  in  the  scale  is  used  as  a  scoop  and  loosely 
filled  with  the  powder;  the  surplus  is  removed  by  passing  the 
sharp  edge  of  the  spatula  across  its  circumference. 

The  scale  is  now  placed  upon  the  fulcrum  and  enough  water 
is  poured  into  the  small  cup  to  balance  the  weight.  This  is  best 
accomplished  by  using  a  rubber  bull)  water  syringe  of  average 
size.  If  the  humidity  in  the  air  be  noticeable  to  a  considerable 
degree,  an  even  balance  will  be  the  correct  amount  of  water  re- 
quired. If  the  atmosphere  be  normal,  a  balance  so  that  the 
small  cup  will  descend  to  rest  upon  the  table  will  be  found  nec- 
essary, and  this  will  require  an  additional  5  drops  of  the  fluid. 
If  the  atmosphere  be  excessively  dry,  the  scale  should  be  evenly 
balanced  and  20  drops  of  water  added  to  this. 

The  plaster  in  the  powder  requires  its  21  per  cent  of  mois- 
ture to  be  thoroughly  satisfied.  It  contains  this  much  in  its 
natural  state  en  ma-sse,  and  it  will  not  be  as  good  a  binder  for 
this  new  mass  unless  supplied  with  the  proper  quota  of  moisture. 

The  rubber  bowl  made  clean  and  dry,  now  receives  the 
water  from  the  small  end  of  the  scale;  it  is  best  to  place  the 
cover  of  the  can  or  a  piece  of  stiff  cardboard  over  that  part  of 
the  scale  which  contains  the  powder,  and  holding  this  cover 
down  upon  the  mass,  the  scale  is  inverted  over  the  bowl,  and 
the  water  poured  into  the  new  receptacle. 

The  scale  is  now  grasped  in  the  other  hand,  the  cover  is 
removed,  and  the  powder  carefully  thrown  into  the  bowl. 

I'sing  the  spatula,  the  powder  is  made  to  take  up  the  mois- 
ture by  agitating  the  mass;  when  that  seems  accomplished,  a 
minute  should  elapse  before  the  mix  is  again  touched,  as  that 


1XYEST.MKXT,    OR    KKFK.UTOK  V,    CO.MPOrXI)  167 

will  give  tiie  plaster  time  enough  to  exhaust  its  gas  making 
tendencies. 

After  the  minute  of  rest,  the  rubber  bowl  is  seated  in  the 
palm  of  the  left  hand  and  the  right  hand  holding  the  spatula, 
broad  side  parallel  with  front  of  the  body,  is  now  agitated  cir- 
cumfercntially  until  the  powder  seems  to  have  taken  up  all  of 
the  water. 

The  mass  is  then  spread  over  the  entire  inner  surface  of 
the  cup,  iii  a  thin  homogeneous  layer.  The  spatula  is  dispensed 
with  and  the  cup  is  taken  up  in  the  right  hand,  flattened  some- 
what by  gentle  pressure  of  the  fingers,  and  gently  hammered 
against  the  edge  of  the  table  or  bench,  and  rotated  after  each 
concussion,  always  remembering  to  keep  the  mass  spread  out 
as  a  thin  layer  over  the  inner  surface  of  the  bowl. 

If  the  mass  is  handled  in  the  manner  described,  any  en- 
closed air  bubbles  will  be  brought  to  the  surface  and  the  contin- 
uous concussion  and  rotation  of  the  bowl  will  cause  their  col- 
lapse. 

The  flakes  of  graphite  will  aid  in  the  gliding  by  of  obstruc- 
tive particles  which  might  otherwise  tend  to  imprison  objec- 
tionable quantities  of  air. 

The  time  spent  in  mixing  the  compound  should  amount  to 
fully  three  minutes,  including  the  one  minute  given  to  the  ex- 
haustion of  the  plaster  in  its  gas  producing  tendency,  unless  an 
automatic  mixer  is  used,  in  which  case,  fully  five  minutes  must 
be  given  to  the  mixing  process  in  order  to  obtain  satisfactory 
results. 

The  quantity  of  water  must  be  increased  while  using  the 
automatic  mixer,  and  that  may  be  definitely  done  by  obtaining 
a  small  steel  ball  %6  inch  in  diameter,  and  dropping  it  into  the 
little  depression  provided  near  the  larger  cup  in  the  scale. 

I  have  been  able  to  obtain  much  better  results  by  using  the 
mixer,  and  I  have  been  able  to  more  definitely  duplicate  my 
results  by  eliminating  the  varying  human  element  in  the  process 
of  mixing. 

The  manner  of  procedure  is  as  follows: 

The  proportions  ol'  water  and  powder  are  measured  off  as 
outlined,  and  put  into  the  cup  of  the  mixing  apparatus;  the 
cover  is  placed  tightly  upon  the  cup,  and  the  mass  is  well  shaken 


CAST  GOLD  AXI)  PORCKLAIX  INLAYS 


Fig.  163. — The  Taggart  automatic  investment  mixer  attached  to  a  lathe 


Fig.  164. — The  Taggart  automatic  investment  mixer  attached  to  its  own  motor,  a 
clock  with   au  alarm  which  rings  when  the  compound  is  ready  for  use. 


INVESTMENT,    OH    HEFJt.UTORY,    COMPOUND  169 

up  for  a  minute,  the  tube  extending  obliquely  or  acutely,  as  the 
ease  may  be,  from  the  cover  of  the  cup,  and  is  then  slipped 
over  the  spindle  which  extends  from  the  apparatus.  This  spin- 
dle projects  anteriorly  and  at  right  angles  from  the  little  gear 
box  which  is  supported  on  a  stand,  and  slipped  tightly  over  the 
shaft  of  the  lathe. 

On  the  upper  part  of  the  gear  box  is  another  projection 
into  which  a  small  alarm  clock  of  special  construction  is 
fastened. 

The  tube  which  extends  obliquely  from  the  cover  contains 
a  horizontal  cut  about  %  inch  down  its  length,  and  that  ter- 
minates into  a  cut  directly  at  right  angles  to  it,  which  cut 
interlocks  with  a  screw  as  periodically  the  spindle  is  rotated  in 
the  sleeve  or  tube  of  the  cup. 

The  periodical  interlocking  of  the  screw  on  the  spindle 
with  the  right  angle  cut  on  the  tube  of  the  cup,  furnishes  the 
necessary  jar  which  breaks  the  air  bubbles,  while  the  incline 
of  the  cup,  due  to  the  position  of  the  tube  upon  the  cover,  causes 
the  material  to  be  spread  in  a  very  thin  layer  over  the  inner 
surface  of  the  cup. 

The  little  alarm  clock,  which  has  been  set  before  operation 
\\  as  begun,  will  at  the  end  of  five  minutes,  notify  in  no  uncer- 
tain terms,  that  the  investment  is  ready  for  use. 

The  power  is  turned  off,  and  the  cup  slipped  off  the  spindle 
and  opened.  The  mix  should  be  found  of  a  smooth  creamy  con- 
sistency. 

With  a  very  small  round  badger  brush  (the  smaller  the 
pattern,  the  smaller  the  brush  should  be)  a  small  quantity  of 
the  mix  is  taken  up  from  the  surface  of  the  mass,  and  placed 
upon  the  wax  pattern  held  upon  the  crucible  former,  in  and 
around  every  corner  and  margin  of  it,  and  this  must  be  done 
with  a  gentle  but  continuous  stroke,  during  which  the  brush 
does  not  leave  the  body  of  the  pattern.  AVhen  the  amount  upon 
the  brush  has  been  deposited  upon  the  pattern,  the  former  is 
made  to  take  up  a  somewhat  larger  amount  from  the  surface 
of  the  mass  contained  in  the  cup. 

Again  the  brush,  carrying  the  creamy  investment,  is  placed 
upon  the  pattern  and  again  it  is  made  to  travel  in  close  prox- 
imity to  the  wax,  depositing  along  its  line  of  travel  the  smooth 


170 


CAST    GOLD    AND    PORCELAIN    INLAYS 


fee 
S 


INVESTMENT,    oil    UEI-'U.U  Toll  V,    C<  >.M  I'OC  XI)  171 

refractory  compound,  until  the  wax  pattern  is  wholly  enveloped 
in  it. 

AVlien  the  wax  has  been  entirely  surrounded  by  investment, 
the  crucible  former  is  grasped  with  the  thumb  and  the  first  two 
lingers  of  the  left  hand,  while  a  faintly  knurled  piece  of  steel  or 
brass,  or  a  medium  grain  rile,  is  drawn  downward  upon  the  edge 
of  the  crucible  former. 

The  flask  is  now  placed  on  the  crucible  former,  and  the 
rest  of  the  investing  compound  is  allowed  to  run  into  the  flask, 
close  to  the  margin,  and  away  from  the  pattern.  When  the 
ilask  has  been  half  tilled,  it  is  rotated  smartly  back  and  forth 
upon  and  around  the  crucible  former,  to  insure  a  complete  fill- 
ing of  the  flask  and  prevent  the  imprisonment  of  air.  The  bal- 
ance or  other  half  of  the  ilask  is  then  filled  with  the  still  fluid 
mass. 

It  must  be  remembered  that  the  instrument  is  to  be  drawn 
downward  only  upon  the  crucible  former,  and  no  seesaw  motion 
of  the  file  or  knurl  against  the  edge  of  the  base  must,  under  any 
circumstances,  be  indulged  in,  and  the  exercise  of  the  instru- 
ment against  the  crucible  former  must  be  exceedingly  careful 
and  gentle,  lest  the  pattern  be  caused  to  fracture,  at  the  point 
where  the  sprue  wire  has  entered  to  support  it  upon  the  base. 

This  will  cause  the  finer  and  smoother  particles  of  the  mass 
to  deposit  themselves  closely  to  the  pattern,  and  insure  a  very 
smooth  mold  and  subsequently  a  very  smooth  cast. 

The  flask,  having  been  generously  filled,  the  invested  pat- 
tern is  now  placed  upon  a  glass  slab,  which  in  turn  is  deposited 
in  some  place  where  it  will  not  be  likely  to  be  disturbed  or 
jarred,  and  thus  it  must  be  allowed  to  stand  until  complete  crys- 
tallization of  the  fluid  investing  compound  has  taken  place. 

Complete  crystallization  of  the  mold  will,  in  dry  weather, 
take  place  in  15  to  35  minutes,  the  time  varying  with  the  mass 
of  the  compound;  in  humid  weather  45  minutes  to  an  hour  may 
elapse  before  it  becomes  advisable  to  touch  the  flask  or  mold. 

The  correct  instant  may  be  recognized  by  the  grayish  white, 
and  silky  appearance  <>!'  the  surplus  present  in  the  flask. 

With  a  sharp  knife,  the  blade  of  which  must  be  longer  than 
the  din  meter  of  the  flask,  this  surplus  is  removed,  so  that  the 
bottom  of  the  mass  is  level  with  the  circumference  of  the  metal 


172  CAST  GOLD  AND  PORCELAIN  INLAYS 

flask,  and  with  this  object  in  view,  the  surplus  is  removed  with 
one  sweep  of  the  knife.  Next  the  flask  is  grasped  in  the  left 
hand,  while  the  thumb  and  index  finger  of  the  right  take  hold 
of  the  crucible  former,  and  turn  it  upon  its  seat  toward  the  left. 
Because  of  the  cone-shaped  seat  of  the  sprue  within  the  crucible 
former,  the  latter  may  be  easily  removed,  carefully  cleansed 
with  a  brush  under  the  running  water,  dried,  faintly  lubricated 
and  put  aside.  With  the  flask  forceps  held  in  the  left  or  right 
hand,  the  flask  is  grasped  midway  and  held  over  a  small  Bunsen 
flame,  in  order  to  heat  the  sprue,  that  it  may  be  readily  disen- 
gaged from  the  wax  inlay  embedded  in  the  mold.  This  is  ac- 
complished 'by  grasping  the  slightly  heated  sprue  wire  with 
the  thumb  and  index  finger,  and  gently  twisting  it  around  and 
outward.  Care  must  be  taken  that  the  edge  of  the  flask  is  clear 

of  any  material. 

• 

SUMMARY  TOR  CHAPTER  X 
The  Investment,  or  Refractory,  Compound 

1.  What  is  the  purpose  of  investment? 

2.  What  is  meant  by  a  refractory   compound?     Why  is  such  a  compound 
necessary? 

3.  What  are  the  necessary  requirements  of  an  invcstinent  compound? 

4.  What  is  the  function  of  plaster  of  Paris  in  an  investment?     Name  the 
three  varieties  of  gypsum. 

5.  Name  the  other  materials  used  as  refractories. 

6.  Describe  the  manner  of  making  the  mix. 

7.  Describe  the  manner  of  investing  the  wax  pattern. 


CHAPTER  XI 

THE  DRYING-  OUT  OF  THE  MOLD  AND  THE  BURNING 
OUT  OF  THE  WAX  MODEL 

Until  some  such  automatic  heating  apparatus  as  shown  by 
the  inventor  of  the  entire  process  is  readily  obtainable,  each 
man  engaged  in  the  work  of  restoring  broken-down  teeth  by 
means  of  cast  gold  inlays  will  have  to  make  the  best  of  the 
means  he  has  at  hand  for  the  burning  out  process,  and  a  good 
serviceable  appliance  can  be  constructed  from  a  medium-sized 
Bunsen  burner,  upon  which  a  spider  of  six-inch  diameter  is 
mounted;  over  that  a  piece  of  latticed  steel  may  be  placed,  and 
surmounting  this  a  sheet-steel  tube,  lined  with  asbestos,  if  pos- 
silile,  and  provided  with  a  handle  at  its  center.  This  tube  should 
be  about  eight  inches  in  height. 

This  apparatus  should  be  placed  upon  a  piece  of  slate  or 
asbestos,  and  it  should  be  surrounded  by  a  piece  of  sheet  metal 
as  to  keep  all  sudden  draughts  away.  I  use  a  Platcheck  furnace, 
in  which  is  placed  a  piece  of  latticed  steel,  and  under  which  is 
adjustably  placed  a  powerful  Bunsen  flame. 

The  furnace  itself,  as  is  shown  in  the  illustration,  consists 
of  two  main  parts  hinged  together. 

The  lower  or  under  portion,  which  furnishes  the  support 
for  the  flasks,  is  provided  with  legs  extending  outward  and 
downward  from  its  underside,  the  spread  of  the  legs  being  suf- 
ficient to  exclude  the  possibility  of  upsetting  the  furnace  when 
the  top  or  cover  is  thrown  back. 

Both  the  upper  and  lower  parts  are  semicircular  in  shape, 
and  are  lined  with  fire  brick.  When  the  furnace  is  closed,  the 
space  inside  of  it  has  the  appearance  of  a  hollow  globe,  or  very 
close  to  it.  It  may  be  readily  seen  that  in  this  way  a  muffle  with 
a  decidedly  advantageous  radiating  surface  is  obtained.  Sup- 
ported upon  a  little  rim  on  the  upper  part  of  the  furnace  is  a 
funnel  of  a  three-inch  diameter  and  about  eight  inches  high; 

173 


174  CAST  GOLD  AX1)  POKCELAIX  INLAYS 

the  diameter  of  the  funnel  gradually  diminshes  until  it  registers 
two  inches  at  its  extreme  height. 

Upon  the  interlaced  steel  wire,  resting  upon  the  fire  brick 
of  the  lower  half  of  this  furnace,  the  metal  flask  containing  the 
mold  is  placed.  Here  the  first  step  in  guarding  against  too 
rapid  heating  must  take  place. 

The  Bun  sen  burner  should  be  set  to  one-third  of  its  capacity, 


Fig.  166. — Taggart  automatic  (gas)  burner  for  removing  wax  pattern  from 
mold.  The  gas  is  made  to  travel  through  the  clock  which,  after  a  set  period,  en- 
larges the  opening  and  allows  the  flame  to  increase.  When  the  flame  has  reached 
its  maximum  and  remained  at  this  height  for  five  minutes,  it  is  automatically 
shut  off. 

and  placed  beneath  the  furnace.  The  flask  is  placed  upon  the 
latticed  steel  wire  frame,  resting  on  the  inside  of  the  lower  part 
of  the  furnace,  and  as  far  away  from  the  center  of  the  flame  as 
the  inner  periphery  of  the  furnace  will  permit. 

The  heater  is  closed  and  the  flask  is  left  there  for  a  period 


PKYIXO    .MOLD    AXD    I'.rilXIXd    WAX    MODEL 


L75 


of  ten  minutes.  If  after  the  time  mentioned,  we  open  the  fur- 
nace to  examine  the  flask.  \\  e  will  find  very  little  moisture  ris- 
ing from  tin-  hod v  of  it,  but  we  will  also  find  a  constant  stream 


Fig.  167. — Platcheck  furnace  closed,  showing  flue,  or  chimney. 

of  fine  vapor  escaping  from  the  sprue  hole  or  gate  in  the  mold. 
This  is,  of  course,  due  to  the  volatilization  of  the  wax.    The  flask 


176 


CAST  COLD  AND  PORCELAIN  INLAYS 


is  now  moved  up  closer  to  the  center  of  combustion,  and  it  is 
best  to  evenly  divide  the  distance  between  the  periphery  of  the 
furnace  and  the  center  of  combustion,  and  place  the  flask  at  that 


Fig.  168. — The  Platchcck  furnace  for  burnino  out  the  wax.  Furnace  open, 
showing  burner  under  it  and  flask  upon  the  wire  net  ready  to  be  subjected  to  the 
flame. 

point.  At  the  same  time  the  burner  is  turned  on  to  two-thirds 
of  its  capacity.  Be  sure  of  a  slow  heat,  so  that  the  moisture 
is  evaporated  rather  than  steamed  out. 


DHYIXtJ    MOLD    AND    BC  II  X  I  \< ;     WAX     MODKL  177 

The  furnace  is  closed  and  allowed  to  remain  in  this  con- 
dition for  about  five  to  ten  minutes,  time  varying-  with  the  size 
of  the  flask,  when  the  furnace  is  again  opened  and  the  flask 
looked  at.  It  will  be  seen  that  the  crucible  lias  over  it  a  coat 
of  carbon. 

"When  the  drying-  period  has  passed,  the  flask  is  placed 
directly  in  the  center  of  the  latticed  steel  wire  frame;  the  Bun- 
sen  llaine  will  then  be  immediately  beneath  it.  The  furnace  is 
closed  and  the  IJunsen  burner  is  adjusted  to  its  full  capacity 
for  one  or  two  minutes.  The  hydrocarbons  will  burst  into  flame, 
after  which  time  the  flame  under  the  furnace  is  extinguished 
and  the  furnace  opened,  to  reveal  a  mold  clear  of  carbon,  or 
any  other  deposit,  and  of  a  grayish  white  color,  speckled  here 
and  there  with  the  iron-gray  of  the  graphite. 

The  flask  is  carefully  grasped  with  the  flask  forceps,  lifted 
off  the  steel  wire  support,  and  carried  onto  a  seat  of  asbestos 
or  slate.  Either  of  the  foregoing  is  to  be  preferred  to  iron, 
because  both  are  nonconductors  and  will,  therefore,  exclude  the 
possibility  of  too  sudden  a  thermal  change,  and  probably  hair- 
like  fracture  of  the  mold. 

It  must  be  understood  that  at  no  time  lias  the  temperature 
of  the  flask  been  raised  to  a  point  that  would  make  it  red  hot, 
or  even  beyond  that. 

The  wax  advocated  for  use  in  this  book  will  volatilize  and 
disappear  at  such  a  comparatively  low  temperature,  that  it 
would  be  folly  to  subject  the  mold  and,  therefore,  the  plaster 
therein,  to  any  uncalled  for  degree  of  heat. 

It  is  well  to  remember  that  the  less  heat  we  employ,  the 
stronger  our  mold  will  be,  and  the  greater  its  resistance  to  in- 
ternal pressure,  and  the  less  distortion  we  shall  cause  inside  of 
the  mold. 

The  flask  is  now  allowed  to  gradually  cool  down  until  it  is 
the  same  temperature  as  the  air  in  the  room,  when  it  will  be 
ready  to  be  put  into  the  seat,  on  the  machine,  in  order  to  re- 
ceive the  metal. 


CHAPTER  XII 

TIIK  CA8TIXI!  OF  THE  MOLTEN  METAL  INTO 
THE  MOLD 

AVe  are  coming  to  the  elucidation  of  that  part  of  the  tech- 
nic  of  the  casting1  of  inlays,  which  has  proved  the  most  active 
battle-ground  for  the  many  and  various  opinions  of  as  many 
writers  upon  the  subject. 

The  hot  mold  or  the  cold  mold,  the  expanded  mold  or  the 
normal  mold,  questions  which,  in  the  minds  of  some,  occupy 
a  place  of  prime  importance  in  the  art  of  casting,  and  I  would 
retrace  my  steps  a  bit  and  bring  again  before  you  some  of  the 
telling  points  in  the  sequence  of  their  occurrence  in  these  vari- 
ous chapters. 

Let  us  all  remember  tenaciously  that  we  are  doing  our  work 
in  a  room  kept  at  a  given  temperature;  all  our  things,  instru- 
ments and  materials,  as  well  as  the  probable  patient  and  the 
tooth,  are  in  that  room  and  subject  to  that  temperature. 

The  cavity  is  prepared  and  we  are  ready  for  the  making 
of  the  wax  inlay. 

The  wax  is  softened  and  put  into  the  cavity,  and  it  is 
caused  to  Iw-rden  under  pressure;  it  is  chilled,  while  a  force 
greater  than  the  intramolecular  attraction  of  it,  is  upon  it  to 
prevent  any  change  of  bulk  or  form. 

Once  chilled  to  proper  size  and  frictional  fit  of  cavity,  no 
change  of  form  or  bulk  of  the  wax  can  take  place  at  that  tem- 
perature. 

The  carving  is  completed  and  the  inlay  is  invested  in  a 
compound;  the  powder  and  the  liquid,  which  make  up  this  com- 
pound, are  placed  in  a  bowl  or  mixer,  at  the  same  temperature 
which  the  wax  inlay  has  been  subjected  to  right  along,  and 
which  temperature  it  can  not  change. 

The  compound  contains  so  little  of  the  active  plaster,  that 
practically,  no  heat  is  evolved  during  the  period  of  crystal- 

178 


CASTIXC     .MOI.TKX    METAL    INTO    MOLD  179 

lization  of  the  mass.  The  wax  pattern  in  tins  mold,  therefore, 
remains  unchanged.  Once  the  mass  is  crystallized  around  the 
unchanged  wax  pattern,  we  arc  justified  in  our  fixed  belief 
founded  upon  sound  reason,  that,  we  have  a  normal  mold. 

A  fixed  belief,  founde-d  upon  sound  reason,  means  nothing 
short  of  definite  knowledge.  \Ve,  therefore,  know  that  up  to 
the  present  point  we  have  done  nothing  toward  creating  or  call- 
ing into  existence,  any  condition  at  variance  with  these  that  are 
essential  to  keep  our  wax  pattern,  and  the  mold  in  which  it  is, 
unchanging  as  to  bulk  or  shape. 

The  flask  is  now  placed  in  the  proper  position,  within  the 
furnace,  the  heat  is  applied  and  gradually  increased,  until  the 
wax  has  been  volatilized  completely;  and  with  the  application  of 
the  heat,  comes  the  change  in  the  size  of  the  mold  and  flask, 
which  gives  at  this  time  a  distorted  mold.  Note  the  word  dis- 
torted, for  this  is  just  what  I  mean  to  convey  to  you;  the  inlay 
is  not  made  larger  evenly  or  in  the  same  ratio  in  all  directions. 

Eefractory  materials  shrink  or  expand,  as  the  square  of 
the  mass,  but  if  we  remember  that  our  wax  patterns  are  not 
cubes,  or  balls,  or  just  flat  surfaces,  or  star-shaped  dreams  of 
even-pointed  bliss,  we  shall  realize  that  perhaps  at  one  point  of 
the  circumference  of  the  wax  of  the  mass  surrounding  an  inlay, 
we  may  have  a  compound  one-fourth  inch  thick  and  one  and 
one-fourth  inches  high;  while  at  the  next  point  of  the  circumfer- 
ence of  the  mass,  it  will  be  three-eighths  inch  thick  and  one  and 
one-fourth  inches  high;  at  a  third  point  of  the  circumference, 
it  may  be  one-half  inch  thick,  and  one  and  one-fourth  inches 
high;  while  on  the  crucible  side  AVC  may  have  it  one-fourth  inch 
high  around  the  entire  circumference,  and  one  the  reverse  side 
of  the  flask,  it  may  be  a  solid  block  of  investment  one-fourth 
inch  deep  by  one  inch  in  diameter. 

AY  here  the  compound  is  thinnest  in  bulk,  it  is  nearest  to 
the  brass  flask,  and  the  influence  of  the  metallic  ring,  as  an  aid 
in  distorting  the  compound  more  at  that  point,  will,  in  a  hot 
Mask,  make  itself  felt  most  decidedly. 

If  we  admit  that  the  expansion  of  the  mold  at  the  thicker 
part  of  it  is  less  likely  to  be  influenced  by  the  metal  ring  (a 
reasonable  admission) ,  and  that,  therefore,  the  expansion  of 
the  part  of  the  mold  would  be  more  likely  to  take  place  in  ac- 


180  CAST  GOLD  AXD  PORCELAIX  IXLAYS 

cordance  with  the  recognized  laws  which  govern  the  minerals 
that  make  up  the  mass,  then  we  must  have  an  expansion  of  this 
mold  which  is  of  very  marked  inequality;  in  other  words,  a 
distortion. 

Into  a  mold  so  distorted,  these  hot  flask  adherents  then  cast 
their  metal,  and  the  result  is  an  inlay  which  is  as  unequally 
enlarged  as  the  mold  was  unequally  distorted. 

All  the  disking  and  stoning,  and  cutting  and  trimming,  can 
not  bring  this  casting  back  to  the  exact  form  required  for  that 
cavity,  for  clearly  no  means  at  our  command  can  make  this 
metal  assume  angles,  lines,  points  and  surfaces,  the  same  as  to 
size,  proportion,  and  direction  as  those  possessed  by  the  wax 
pattern. 

The  fact  that  some  men  do  put  these  inlays  into  cavities 
proves  nothing  except  that  they  are  content  with  the  results 
they  obtain,  and  that,  of  course,  is  no  proof  of  the  correctness 
of  their  method. 

The  men  who  realize  the  truth  of  the  foregoing,  will,  after 
the  complete  volatilization  of  the  wax,  allow  this  flask  to  resume 
its  normal  size,  and  the  mold  within  to  come  back  to  its  original 
proportions.  This  can  only  be  accomplished  by  allowing  the 
mass  and  flask  to  become  stone  cold;  that  is,  resume  the  room 
temperature. 

The  cold  flask  adherents,  realizing  that  the  correct  com- 
pound they  use  for  investment  is  so  well  balanced  in  its  com- 
ponents of  plaster  and  silex  that  the  expansion  of  the  latter 
nullifies  the  contraction  or  shrinkage  of  the  former,  are  content 
to  carefully  and  thoroughly  volatilize  the  wax  and  allow  those 
two  components  to  return  to  their  original  condition,  by  allow- 
ing the  mold  and  flask  to  rid  itself  of  its  heat.  Thus  they  ob- 
tain, after  the  volatilization  of  the  wax,  a  mold  of  exactly  the 
same  size  as  the  wax  pattern,  which  they  put  into  it,  and  which 
has  now  disappeared,  and  this  mold  is  of  the  same  temperature 
now,  when  it  is  ready  for  the  metal,  as  it  was  when  it  contained 
the  wax  pattern.  It  was  unable  to  alter  its  shape  and  propor- 
tion then;  it  is  unable  to  remain  distorted  when  allowed  to  cool. 
The  accession  of  the  heat  which  caused  its  unequal  distortion, 
will,  by  its  gradual  disappearance,  compel  the  compound  to  re- 
sume its  normal  condition.  I  feel  that  I  can  not  be  too  emphatic 


(.'ASTIXC    MOI.TKX    MKTA1,    INTO    A1OU>  1S1 

about  tliis.  Xot  only  is  the  cold  fla.sk  in  harmony  with  the  phys- 
ical laws,  but  it  has  proved  itself  correct  in  this  practical  work 
and  clinical  experiments.  They  who  rail  against  it  have  slipped 
up  somewhere  in  their  technic,  and  they  are  putting  the  blame 
on  the  wrong1  shoulders. 

Let  them  try  again,  work  out  every  step  carefully,  and  fol- 
low directions  implicitly.  It  will  pay;  for  they  will  obtain  re- 
sults that  are  correct,  and  1  am  willing  to  assume  that  they 
are  eager  for  such  results.  A  cold  flask  it  is  then,  at  least  for 
tin-  confines  of  this  volume,  anil  for  those  who  desire  to  follow 
the  technic  outlined  herein. 

Perhaps  it  will  be  as  well  to  say  here,  that  unless  every 
step  of  this  technic  be  carried  out  as  outlined,  I  consider  myself 
absolved  from  any  responsibility.  I  willingly  and  confidently 
promise  results,  providing  the  reader  will  follow  instructions  to 
the  letter,  but  I  will  not  submit  to  any  deviation  on  the  part 
of  the  reader,  nor  will  I  brook  any  substitutions  for  portions  of 
this  technic;  no  short  road  to  Rome — no  better  or  quicker 
method  in  part.  If  any  supplanting  of  method  be  done,  it  must 
be  so  supplanted  as  a  whole. 

This  technic  interdigilates  and  dovetails  in  every  step  or 
degree,  ami  it  has  been  carefully  worked  out  to  do  just  that. 
A  change  in  any  part  means  a  disturbance  of  the  equilibrium 
and  indifferent  results — something  to  be  avoided. 

SUMMARY  TOR  CHAPTER  XII 
The  Drying  Out  of  the  Mold  and  the  Burning  Out  of  the  Wax  Model 

1.  Describe  a  simple  heating  apparatus  for  use  in  the  burning  out  process. 
-.  Describe  the  Platcheck  furnace. 

3.  Describe  the  manner  of  manipulating  the  flame  to  insure  the  proper  dry- 
ing and  burning  out  without  bringing  the  flask  to  a  red  hot  condition. 


CHAPTER  XIII 
THE  METALS  FOE  THE  INLAY  WORKER 

Though  gold,  platinum,  silver,  copper,  and  all  the  metals  of 
the  platinum  group  have  their  measure  of  application  in  inlay 
work,  only  gold  and  platinum  will  be  considered  for  the  pur- 
pose of  this  work. 

I  want  to  lay  stress  upon  the  fact  and  have  it  clearly  un- 
derstood that  when  I  speak  of  metals  at  all  I  speak  of  them  in 
a  pure  state,  or  rather  in  a  commercially  pure  state.  So  that  in 
considering  gold,  it  is  understood  to  be  pure  gold,  24  carat  fine, 
and  in  considering  platinum  it  is  understood  to  be  pure  plat- 
inum, soft  platinum,  as  soft  as  the  refiner  can  furnish  it  in  sheet 
or  foil  state,  as  devoid  of  iridium  as  it  can  be  made. 

We  have  been  in  the  habit  of  speaking  of  metals  as  royal 
or  noble  metals  and  base  metals.  Royal  metals  are  capable  of 
being  separated  from  combinations  with  oxygen  by  merely 
heating  them  to  redness.  Base  metals  are  those  whose  com- 
pounds with  oxygen  are  not  decomposable  by  heat  alone.  Gold 
and  platinum  belong  to  the  royal  metals. 

Gold:  symbol  Au;  combining  weight  197.7;  fusing  point 
2004°  F.,  1050°  C.,  specific  gravity  19.3  to  19.5. 

Platinum:  symbol  Pt;  combining  weight  193.3;  fusing  point 
3225°  F.  to  3425°  F.,  1650°  C.  to  1775°  C.;  specific  gravity  21.5. 

A  quantity  of  pure  gold  depending  upon  the  needs  of  the 
case,  a  certain  amount  of  very  thinly  rolled  out  platinum,  a 
seasoned  charcoal  block,  a  mixture  of  potassium  nitrate  and 
borax,  two-thirds  of  the  former  to  one-third  of  the  latter,  which 
is  contained  in  a  suitable  receptacle,  a  pair  of  brown  or  ambei- 
colored  glasses,  a  nitrous  oxide  blowpipe,  a  pair  of  platinum- 
tipped  foil  carriers,  and  an  asbestos  or  slate  pad,  the  latter  tc* 
be  preferred,  make  up  the  necessary  metallurgic  equipment  for 
a  laboratory  where  inlays  are  to  be  made. 

The  gold  may  be  in  the  shape  of  heavy  sheets  or  ingots, 
the  platinum  must  be  in  either  very  thinly  rolled  or  foil  form. 

182 


Ml.TALS    FOR    THE    IXLAV    WOKKEIi 


is:; 


A  seasoned  charcoal  block  is  one  which  lias  been  carefully  and 
gradually  lieated  or  roasted  over  a  low  heat  until  the  danger 
of  its  disruption  when  subjected  to  intense  heat  is  eliminated. 
A  >trong  copper  wire  is  then  wound  around  the  charcoal  block 
and  the  loose  ends  of  the  wire  are  tied.  AVith  a  suitable  instru- 
ment a  depression  is  made  deep  enough  to  hold  the  required 
quantity  of  metal,  and  care  should  be  exercised  to  have  the  walls 
of  this  impression  or  cavity  perfectly  smooth  and  to  have  no 
loose  bits  of  carbon  present. 

If  we  are  now  to  alloy  a  certain  quantity  of  gold  and  plat- 
inum, we  will  proceed  as  follows:  the  gold,  definitely  weighed, 
is  so  placed  in  the  crucible  that  all  of  it  lies  below  the  margin 
of  the  depression.  Before  proceeding  with  the  application  of 


Fig.  n;j). — _\  charcoal  block  with  a  depression  in  it  to  act  as  a  crucible.  A. 
copper  wire  tied  around  this  block  will  prevent  such  accidents  as  the  sudden  dis- 
ruption of  it  when  subjected  to  great  heat  at  one  point.  These  blocks  should 
be  thoroughly  seasoned,  as  explained  elsewhere  in  this  book. 

the  nitrous  oxide  blowpipe  to  the  gold,  platinum  must  be  pre- 
pared first  by  cutting  it  in  very  narrow  strips,  not  over  VIG  or 
%2  of  an  inch  wide,  and  as  thin  as  it  can  be  obtained.  The  nec- 
essary quantity  of  this  material  is  now  placed  upon  a  sheet  of 
white  paper,  so  that  the  individual  pieces  may  be  easily  dis- 
tinguished. 

AVe  are  now  ready  to  proceed  with  our  melt.  The  city  gas 
is  opened,  and  the  flame  is  lit,  the  nitrous  oxide  cylinder  valve 
is  opened  and  the  gas  is  allowed  to  flow  into  the  mixing  cham- 
ber to  unite  with  the  city  gas  to  give  the  necessary  heat  units. 
BO  as  to  efficiently  bring  the  metal  to  the  required  temperature. 


184  CAST  GOLD  AND  POKCELA1X  INLAYS 

The  hottest  part  of  a  nitrous  oxide  flame  is  at  the  first  third  of 
its  exit  from  the  blowpipe  and  the  successful  combustion  of 
nitrous  oxide  and  city  gas  is  one  that  consists  of  a  continuous 
pencil  of  a  clear,  bluish  green  name,  covered  by  a  short  mantle 
of  red  rays,  sparingly  distributed  round  the  bluish  green  flame 
at  its  immediate  source,  and  reaching  only  for  about  %  to  1  inch 
of  its  length.  The  whole  flame  for  the  melting  of  the  metal 
in  the  crucible  should  be  about  4  inches  long  and  this  necessi- 
tates the  reduction  of  the  supply  of  city  gas  to  the  requisite 
amount. 

The  operator  must  now  don  his  amber-colored  glasses  and 
the  flame  is  now  played  on  the  gold  contained  in  the  crucible, 
the  flame  being  no  more  than  1%  to  2  inches  away  from  the  gold. 

The  application  of  the  flame  must  be  constant,  the  hand 
must  be  steady,  and  there  must  be  no  drafts  in  the  room.  The 
first  sign  of  effective  work  will  manifest  itself  in  a  loss  of  def- 
inition as  to  outline  and  boundary  of  the  various  pieces  of  gold. 
They  will  appear  to  collapse,  to  give  up  their  identity  and  will 
go  from  a  state  of  redness,  from  a  shapeless  to  a  spheroidal 
mass  into  a  state  of  incandescence,  thence  to  a  violet-colored, 
heaving  mass,  in  which  the  repelling  and  the  attraction  of  its 
component  molecules  seem  to  be  alternating  phenomena,  fol- 
lowing each  other  with  a  rhythmicity  and  a  periodicity  which 
might  be  definitely  measured  if  one  felt  so  inclined. 

At  this  time,  a  piece  of  the  narrow  platinum  foil  is  grasped 
with  the  platinum-tipped  foil  carriers  and  fed  into  the  still 
constantly  boiling  mass  of  gold,  until  it  has  been  completely 
absorbed.  This  process  of  feeding  the  platinum  is  continued 
until  the  required  amount  of  this  metal  has  been  taken  up  by 
the  larger  mass,  after  that  the  flame  is  still  held  over  the  danc- 
ing fluid  gold  and  it  is  kept  in  a  violent  state  of  agitation  for  a 
period  of  time,  varying  directly  as  the  quantity  of  metal  being- 
handled,  the  periods  being  about  as  follows:  1  oz.  of  an  alloy 
containing  pure  gold  and  2%  to  5  per  cent  of  platinum  must  be 
kept  after  the  entire  amount  of  platinum  has  been  taken  up  by 
the  molten  mass,  in  a  state  of  constant  agitation  for  at  least 
two  minutes.  The  alloy  will  be  much  more  homogeneous  if  this 
period  is  prolonged.  If  the  alloy  contains  a  greater  percentage 
of  platinum,  between  5  and  10  per  cent,  the  period  of  time  re- 


METALS    FOR    TIIK    IXJ.AV    WOKKKU  1s") 

quired  for  constant  agitation  should  be  no  less  than  five  min- 
utes. If  the  alloy  contains  a  quantity  of  platinum  greater  than 
10  per  cent  and  up  to  15  per  cent,  the  period  of  agitation  is 
from  seven  to  ten  minutes.  The  alloy  must  be  allowed  to  cool 
after  tliat,  must  be  rolled  out  into  sheets,  cut  into  small  sections, 
again  remelted  and  agitated  for  from  seven  to  ten  minutes.  In 
a  certain  quality  of  casting  gold  used  which  among  other  things 
contains  19  per  cent  platinum,  which  platinum  in  turn  contains 
'2  per  cent  indium,  the  mass  is  fused,  the  platinum  is  fed  in, 
then  the  entire  mass  is  agitated  for  fifteen  minutes,  an  ingot  is 
made  and  this  rolled  out  into  sheets,  then  remelted,  etc.  This 
process  is  repeated  four  times  and  the  period  of  agitation  is 
longer  each  time,  so  that  at  the  fourth  time  the  period  lasts  be- 
tween twenty-five  and  thirty  minutes. 

When  the  period  of  agitation  has  passed,  the  flame  is  ex- 
tinguished, the  mass  is  allowed  to  cool,  and  it  is  not  to  be 
touched  until  it  has  thoroughly  crystallized,  when  it  may  be 
picked  up  with  the  platinum-tipped  foil  carriers  and  placed  into 
a  hydrochloric  acid  bath,  and  then  rinsed  with  plenty  of  cold 
water.  If  the  quantity  of  metal  is  an  ounce  or  nearly  an  ounce, 
it  may  be  divided  into  four  parts  by  using  the  cold  chisel  and  the 
hammer.  The  anvil  must  be  clean  and  a  sheet  of  white  paper,  or 
better,  cardboard,  must  be  placed  upon  it.  When  the  mass  has 
IMM-II  separated,  each  individual  piece  must  be  first  boiled  in 
nitric  acid,  then  washed  in  water,  then  melted  in  the  charcoal 
block  with  the  nitrous  oxkle  blowpipe,  agitated  for  a  minute  or 
so,  allowed  to  crystallize,  transferred  to  the  hydrochloric  acid, 
again  thoroughly  washed  in  water,  and  put  away  for  future  use. 

No  surplus  of  any  casting  should  be  used  again,  unless  it 
has  been  refined  by  thoroughly  fusing  it  and  sprinkling  it  lib- 
erally with  the  powders  contained  in  the  receptacle  holding  the 
potassium  nitrate  and  borax.  The  melting  process  from  then 
on  is  continued  as  is  the  period  of  agitation,  as  previously  out- 
lined. 

Gold  for  inlays  for  patients  between  twenty-five  and  forty- 
iive  years  of  age,  where  teeth  are  in  fairly  normal  occlusion: 


Pure   gold    ..............  4fi5^  grains 

Pure  platinum    ..........   14  Vd       '  ' 


186  CAST  GOLD  AND  PORCELATX  IXLAYS 

Gold  for  inlays  for  patients  where  teeth  are  in  nialrelation 
and  where  the  stress  of  occlusion  is  varying'  in  direction  and 
very  intense : 

Pure   gold    456  grains 

Pure  platinum    24       " 

Gold  for  inlays  for  teeth  in  normal  occlusion: 

Pure   gold    492^6  grains 

Pure  platinum    T1/^       " 

Gold  for  inlays  for  teeth  that  are  very  frail : 

Pure   gold    432      grains 

Pure  platinum    38V>       ' ' 

Pure   silver    91/..       " 

Gold  for  cast  bases: 

Pure   gold    456  grains 

Piire  platinum    24       " 

Gold  for  saddles: 

(1)  Pure   gold    384  grains 

Platinum    2%    iridium    72       " 

Pure  silver 18       " 

Pure   copper    6       " 

(2)  Coin    gold    432  grains 

Platinum  2%    iridium    48       " 


SUMMARY  FOR   CHAPTER  XIII 
The  Metals  for  the  Inlay  Worker 

1.  What  metals  are  commonly  used  by  the  inlay  worker? 

2.  What  are  the  materials  and  the  instruments  necessary  to  make  a  com- 
plete metallurgic  equipment? 

3.  In  what  form  should  gold  and  platinum,  respectively,  be  used? 

4.  Describe  the  making  of  the  melt. 


THE  CASTIXU  OF  THE  MOLT  MX  MKTAL  INTO  THE 

MOLD  AX!)  A  ( '<  )XSI  DKUATIOX  OK  TIIU  YAKIOUS 

M A(  11 1 1 XlvS  EMPLOYED 

At  this  stage  of  the  work  we  are  ready  to  put  our  cold  flask 
into  the  seat  of  the  machine  with  which  the  casting  is  to  be  done, 
and  before  we  do  that  let  us  consider  and  carefully  examine 
some  of  the  things  that  have  been  said  in  regard  to  the  casting 
of  gold.  AVe  shall,  however,  first  establish  the  truth  of  the  fol- 
lowing statement: 

"All  metal  castings  are  made  under  pressure." 

It  must  be  apparent  to  anyone  who  thinks,  that  even  if  no 
apparatus  of  any  kind  is  used  in  forcing  metal  into  a  mold, 
there  is  still  the  pressure  of  the  falling  metal  to  be  accounted 
for.  It  matters  not  what  we  call  it,  gravitation,  or  anything 
else,  the  fact  remains  that  what  we  are  trying  to  put  into  the 
receptacle  has  some  weight,  and  if  this  weight  is  great  enough 
to  overcome  the  resistance  of  the  air  in  the  mold,  and  if  the 
mold  be  porous  enough  to  allow  that  air  to  escape,  then  we  shall 
have  a  casting,  and  the  very  fact  that  we  get  a  casting,  proves 
that  the  resistance  of  the  air  was  overcome,  and  to  overcome 
resistance  we  must  have  pressure. 

Of  course,  the  relation  between  the  size  of  the  gate  in  the 
mold,  and  the  success  of  the  casting,  with  what  may  be  called 
the  inherent  pressure  of  the  metal,  is  a  factor  to  be  carefully 
taken  into  consideration.  The  gate  must  be  larger  in  casting 
by  this  method  than  it  would  have  to  be  if  we  had  the  aid  of 
some  outside  agent  to  increase  the  pressure,  and  confine  it  to 
a  circumscribed  area. 

It  is  not  advisable  to  use  this  method  in  casting  any  of  the 
royal  metals,  because  of  the  excessively  high  fusing  point  of 
these  metals,  and  the  almost  impossible  task  of  keeping  these 
metals  at  a  temperature  required,  in  order  to  have  them  fluid 

187 


188  CAST  GOLD  AND  POHCELAIX  IX LAYS 

enough  for  a  long  enough  period  of  time  to  complete  a  easting 
by  tliis  method. 

It  has  been  and  is  being  employed  in  casting  low-fusing 
alloys,  used  in  the  laboratory  for  lower  dentures.  Most  men 
will  be  familiar  with  the  method;  that  is,  the  preparation  of 
the  model;  the  making  of  the  wax  pattern,  with  its  two  in- 
verted, cone-shaped  extensions  at  the  condyles;  the  investment 
of  this  model  carrying  this  pattern  into  one-half  of  a  special 
flask  in  such  a  manner  that  only  half  of  the  wax  pattern  and 
inverted  cone  extensions  will  be  embedded  into  the  plaster  and 
sand,  the  subsequent  lubrication  of  that  half  of  the  investment 
and  wax,  and  the  placing  and  filling  with  plaster  and  sand  of 
the  other  half  of  the  flask,  the  drying  of  the  flask  containing 
the  invested  pattern  and  model;  the  opening  of  the  flask  and 
the  boiling  out  of  the  wax;  the  careful  drying  out  of  the  mold 
until  the  mirror  test  shows  it  to  be  devoid  of  moisture,  and 
finally  the  melting  of  the  alloy  in  a  suitable  crucible;  the  as- 
sembling of  the  two  halves  of  the  flask,  and  the  pouring  of 
the  molten  alloy  into  one  of  the  funnel-shaped  openings  at  one 
side  of  the  flask,  until  we  see  the  metal  rise  in  the  funnel-shaped 
openings  at  the  other  side  of  the  same  flask. 

If  the  side  of  the  flask  which  contains  the  funnel-shaped 
opening  in  which  the  metal  rises,  were  longer  by,  let  us  say, 
an  inch,  than  the  side  which  contains  the  funnel-shaped  opening, 
into  or  by  way  of  which  we  pour  the  metal,  we  could  continue 
the  pouring  until  the  metal  on  the  escape  side  had  risen  a  full 
inch  higher  than  the  metal  on  the  intake  side.  If  there  were 
no  inherent  pressure  in  the  metal  being  poured  into  the  intake 
side,  this  could  not  take  place,  and  it  is  also  true  that  this  pres- 
sure is  as  the  weight,  and  is,  of  course,  partly  subject  to  the 
same  laws  as  those  which  govern  falling  bodies. 

I  think  it  is  pretty  well  proved  that  casting  as  described 
above,  is  pressure  casting;  and  I  think  also  that  I  can  save  space 
and  time  by  simply  stating  that  the  method  described  above 
is  entirely  and  absolutely  unfit  for  the  casting  of  inlays,  without 
going  into  any  lengthy  dissertation  as  to  why  this  is  so. 

What  is  true  of  the  simple  process  above  described,  holds 
good  in  dental  casting  by  means  of  centrifugal  force,  whether 
we  make  use  of  one  of  the  centrifugal  casting  machines  sold 


CASTIXt;    .MOI.TKX     .MKTAI.— MATH  INKS    KM  IM.( )  VKD  189 

for  this  purpose,  or  simply  swing  a  bucket  containing  the  mold, 
and  the  molten  metal  in  a  circle  with  sufficient  rapidity  to  cause 
this  molten  metal  to  bury  itself  in  the  space  provided  in  the 
mold. 

That  this  centrifugal  force  must  be  converted  into  pres- 
sure before  it  can  cause  the  metal  to  seek  the  cavity  in  the  mold, 
is  proved  by  the  fact  that  all  forces  finally  expend  themselves 
in  pressure  of  one  kind  or  another,  so  that  a  casting  made  by 
the  centrifugal  method  is  essentially  a  pressure  casting,  and  if 
this  centrifugal  force  could  in  any  way  be  definitely  confined 
and  doled  out  in  given,  definite,  and  measurable  quantities,  it 
would  have  points  in  favor  of  its  use.  At  present  I  know  of  no 
apparatus  in  which  this  principle  is  utilized  that  could  be  said 
to  be  dependable  enough  to  Avarrant  its  use  in  the  casting  of 
gold  inlays.  No  claim  made  by  the  vendors  or  manufacturers 
of  these  centrifugal  casting  machines  has  been  sustained.  The 
(|iiaiitity  of  the  force,  and  hence  the  amount  of  pressure  used, 
being  unknown,  the  best  one  can  say  of  the  possible  result  is 
that  it  will  be  doubtful.  I  used  one  of  these  machines  alongside 
of  many  other  makes,  and  after  careful,  conscientious  efforts, 
I  was  forced  to  the  conclusion  that  no  acceptable  inlay  can  be 
made  by  this  process.  The  machine  has  its  use  perhaps  in  the 
arts  and  crafts  of  jewelry  castings,  and  in  coarse  laboratory 
work,  where  things  cast  may  afterwards  be  filed  out  to  definite 
measurements,  but  it  is  not  to  be  considered  for  inlay  work. 

The  most  commonly  employed  centrifugal  machine  consists 
of  a  base  with  a  centrifugal  pivot,  to  which  is  fastened  one  end 
of  a  coiled  spring  and  a  flywheel  with  a  recess  in  the  under  side. 
This  flywheel  is  mounted  movably  upon  this  central  pivot  of 
the  base,  and  the  coiled  spring,  one  end  of  which  is  fastened  to 
the  central  pivot,  is  attached  at  the  other,  or  outer,  end  to  the 
My  wheel,  and  enclosed  in  the  recess  of  it.  Externally  to  the 
frame  or  base  is  a  bar  which  actuates  a  leather-covered  lever 
arm  which  coacts  with  the  flywheel  to  hold  it  in  a  given  position 
after  the  spring  has  been  wound  up.  This  makes  up  the  en- 
rlo.-ed  mechanism  of  the  machine. 

The  exposed  part  consists  of  an  arm,  fastened  to  the  fly- 
wheel by  means  of  screws,  entering  a  small  cylindrical  por- 
tion of  this  flywheel.  A  pivot  about  three-quarters  of  an  inch 


190  CAST  GOLD  AND  PORCELAIN  INLAYS 

in  height,  rises  from  this  crossarm  and  serves  as  a  handle  to 
wind  up  the  spring  by  rotation  of  the  flywheel.  On  each  end 
of  this  crossarm,  is  a  headed  rivet  upon  which  a  sliding  ad- 
justable arm  is  carried,  and  one  of  these  end  arms  carries  the 
tray  which  contains  the  flask  and  mold,  while  the  other  one 
carries  the  counterbalance. 

When  the  mold  is  ready  to  be  filled,  the  flask  is  slipped 
into  the  carrier  on  the  end  of  the  mold  arm.  The  spring  hav- 
ing been  wound,  the  adjustable  arms  are  set  at  right  angles  to 
the  crossbar,  or  very  nearly  right  angles.  The  crucible  in  which 
the  gold  is  to  be  melted  is  placed  upon  the  carrier  immediately 
in  front  of  the  flask.  The  gold  is  melted,  and  when  it  boils,  the 
flywheel  is  released,  which  sets  it  in  motion,  which  motion  is 
transmitted  to  the  crossarm,  and  from  it  to  the  end  placed  ad- 
justable arms,  which  immediately  straighten  out,  with  tremend- 
ous outward  motion,  and  this  forces  the  molten  metal  into  the 
mold. 

In  a  few  moments  the  maximum  velocity  will  have  been 
reached,  and  from  this  point,  the  speed  of  the  machine  will 
decrease.  It  may  be  either  allowed  to  spend  itself,  or  it  may, 
after  one  and  one-half  minutes  be  stopped  by  pushing  the  leath- 
er-covered lever  against  the  flywheel. 

The  manufacturers  of  this  machine  claim  that  the  force 
may  be  modified  by  fewer  windings  of  the  spring,  and  while  this 
is  undoubtedly  correct,  the  pressure  produced  remains  indefinite 
and,  therefore,  not  suitable  for  our  purpose. 

With  the  greatest  care  used  in  every  step  of  the  wrork,  all 
inlays  made  were  more  or  less  irregularly  distorted,  due,  no 
doubt,  to  a  forced  readjustment  of  the  walls  of  the  inside  of 
the  mold,  this  readjustment  being  actuated  by  the  impact 
created  first,  by  the  violent  straightening  of  the  arm,  and  its 
consequent  slipping  upon  the  pivot,  and  second,  by  the  impact 
of  the  metal  against  the  wall  of  their  frail  investing  compound. 

While  the  defective  investment  may  be  eliminated,  the  agi- 
tated mold  remains  as  a  permanent  deleterious  agent  in  the  pres- 
ent machine,  and  it  seems  doubtful  if  it  ever  can  be  remedied. 

If  this  machine  is  to  take  a  lasting  place  in  the  art  of 
casting  inlays,  I  would  suggest  that  a  device  be  added  to  it  that 
would  enable  the  operator  to  so  wind  the  spring,  and  so  set  the 


CASTIXC    MOLTKX    .MKTAL MACHIXKS    K.M  PLOYED  1  !H 

flask  that  both  the  momentum  of  the  flywheel  and  the  shock 
with  which  the  flask  is  caused  to  straighten  or  throw  itself  away 
from  the  center,  may  be  measured.  This  is  not  at  all  impossible, 
and  simply  means  a  year  or  so  of  constant  experiment  and 
mathematical  deduction.  The  manufacturers  would  then  have 
a  product  which  they  would  be  justified  in  offering  to  the  pro- 
fession for  accurate  work,  provided,  of  course,  that  their  experi- 
ments did  not  compel  their  honest  conclusion  that  at  its  best  the 
machine  would  be  unfit  for  inlay  work. 

Regardless  of  any  assertions  to  the  contrary,  most  vehe- 
mently made  by  the  manufacturers  of  the  vacuum  machines,  they 
are  nothing  else  than  pressure  machines;  and  in  order  to  prove 
this,  it  is  only  necessary  to  quote  a  small  part  of  their  glowing 
literature  full  of  little  jokes. 

''Not  the  slightest  fraction  of  an  ounce  of  artificially  pro- 
duced prt'xxxre  is  applied  at  any  stage  of  the  casting  operation, 
when  an  Elgin  is  the  apparatus  used.  There  is  not  the  slightest 
fraction  of  an  ounce  of  artificially  produced  resistance  to  be 
oven-nine,  because  the  air  in  the  mold  is  removed  in  advance, 
and  is  not  subject  to  compression. 

"Pressure  is  not  necessary  because  there  is  no  resistance. 
There  is  no  resistance,  the  air  necessarily  and  naturally  is  re- 
moved in  advance  of  the  entrance  of  the  metal,  through  the 
pores  of  the  investment  material  which  are  plenty  large  enough, 
no  matter  how  small  they  may  be,  to  permit  the  instantaneous 
passage  of  the  air  in  response  to  the  pull  of  a  vacuum  formed 
1lic  mold,  a  puU'uif/  force  more  than  double  normal  at- 
ic  prepare."  (Dental  Casting,  1912,  The  Ransom  & 
Randolph  Company.) 

If  any  evidence  be  needed  to  prove  that  the  suction  ma- 
chines are  pressure  machines,  the  little  booklet  containing  the 
above  quotation,  and  many  other  sayings  quite  as  contradictory 
will  supply  that  evidence  gratis. 

Just  think  of  this  wonderful  pulling  force,  dragging  on  the 
vitals  of  the  mold,  and  keeping  up  this  drag  even  after  the 
gold  begins  to  enter,  with  a  force  equal  to  double  that  of  at- 
mospheric pressure,  to  wit:  thirty"  pounds  to  a  square  inch. 

Of  course  as  fast  as  this  machine  sucks  the  air  through 
the  mold  and  creates  a  vacuum,  the  atmosphere  above  would 


192 


CAST  GOLD  AND  PORCELAIN  INLAYS 


be  inert  if  it  did  not  push  or  press  the  gold  into  this  vacuum 
much  abhored  by  nature;  and  because  this  pull  is  so  strong, 
in  other  words,  because  this  sucking  apparatus  is  so  voracious, 


Fig-.  170-.-J. — The  Elgin  vacuum  casting  machine  and   Masks. 


Fig.  I70-B. — Same  machine  as  in  Fig.  170-J,  ready  for  casting. 

• 

the  abused  and  harassed  atmosphere  above   must  exert  this 
thirty  pounds  to  the  square  inch  pressure  nolens  volens. 

All  this  time  the  molecular  integrity  of  the  mold  is  being 


C'ASTIXC    MOLTKX    .MKTAI/ — MACHINES    EMPLOYED  1!).'! 

attacked  by  this  plus  suction  in  order  to  allow  the  gold  to  enter 
without  any  duress  except  the  double  atmospheric  pressure,  the 
pull  of  the  plus  suction  equals. 

It  will  be  well  to  note  that  the  natural  atmospheric  pres- 
sure upon  the  earth  at  our  level  is  about  tifteen  pounds  to  the 
square  inch,  and  anything  above  that  is  an  artificially  produced 
pressure,  which  makes  their  statement  in  the  beginning  of  the 
quotation,  seem  very  far  from  an  accurate  scientific  assertion. 

To  cite  another  quotation  with  the  reader's  indulgence,— 
but  first  the  digression  to  recall  to  your  mind  that  we  must 
thresh  these  things  out  to  settle  them,  for  at  least  some  time  to 
come, — it  will  be  well  to  quote  from  the  same  booklet,  page  4, 
beginning  on  line  25: 

"In  casting  by  other  than  the  vacuum  method,  the  excess 
metal  in  the  crucible  is  the  first  to  solidify,  thereby  shutting 
off  the  pressure.  Pure  gold,  especially  shrinks  in  the  process 
of  hardening,  and  with  the  excess  solidified,  and  the  pressure 
removed,  the  metal  in  the  mold  contracts  to  the  extent  of  the 
shrinkage. 

"\Yith  the  Elgin,  the  first  portion  to  harden  is  the  metal 
against  the  outer  walls  of  the  mold,  and  the  last,  the  excess  in 
the  crucible,  while  in  all  other  forms  of  cnstntfi,  the  process  is 
reversed. 

"In  using  the  Elgin  appliance,  the  excess  can  be  kept  mol- 
ten, and  the  suction  maintained,  as  long  as  required  for  the 
metal  to  completely  harden  in  the  mold.  Simultaneously  with 
the  shrinkage  taking  place  in  the  mold,  the  vacuum  draws  metal 
from  ,v//7/  molten  r.iccss  to  fill  the  vpnce  left  by  the  natural 
shrinkage." 

The  colossal  impertinence  of  sending  a  booklet  containing 
such  statements  to  men  who  are  supposed  to  have  had  at  least 
a  primary  lesson  in  metallurgy,  can  only  be  accounted  for  in 
two  ways:  It  may  be  that  the  man  that  wrote  this  statement 
in  the  Koranic  booklet  really  believed  he  was  telling  the  truth, 
and  it  may  be  that  if  he  knew  he  was  wrong,  he  figured  that 
none  of  the  men  would  read  it  with  enough  attention  to  find 
the  pig,  and  if  they  did,  they  would  not  know  the  difference 
anyway. 

I  have  seen  beautiful  jewelry,  such  as  elks'  heads,  cast 


194  CAST  GOLD  AND  PORCELAIN  INLAYS 

upon  an  Elgin  machine,  but  I  have  never  yet  in  my  practice, 
been  called  upon  to  insert  an  elk's  head  into  a  patient's  tooth, 
to  take  the  place  of  an  inlay.  I  have  seen  Greek  letters  and 
coiled  springs  and  scimitars  which  were  sucked  into  an  Elgin 
and  atmosphered  twice  over  again,  but  none  of  those  things 
have  ever  been  called  upon  to  measure  up  with  any  micrometer 
measurement. 

It  will  be  well  for  the  student  and  practitioner  to  bear  in 
mind  that  we  are  called  upon  to  inlay  teeth,  and  to  inlay  them 
with  microscopic  correctness.  True,  we  can  appreciate  fine 
jewelry,  nice  rings,  decorated  with  figures  or  hieroglyphics,  and 
no  doubt,  if  we  ever  leave  our  profession  to  enter  the  field  of 
tlie  art  metal  worker,  these  machines  may  have  their  uses,  but 
so  far  as  I  have  been  able  to  determine,  they  are  failures,  and 
an  ordinary  little  swage,  with  its  air-compressing  interior,  is 
to  be  preferred. 

The  vacuum  machine  is  a  pressure  machine;  of  that  there 
is  no  doubt,  and  if  it  were  not  such  an  inverted  pressure  ma- 
chine, it  might  be  useful. 

I  take  it  that  the  reader  will  have  come  to  the  conclusion 
that  I  am  an  advocate  of  a  direct  pressure  machine,  and  this 
conclusion  is  sound.  I  have  my  reasons,  too,  for  preferring  and 
using  and  advocating  the  direct  pressure  machine,  provided  it 
is  the  right  kind.  The  right  kind  of  pressure  machine  is  one 
which  will  perform  the  following  service : 

It  must  enable  one  to  melt  the  gold  in  the  crucible  of  the 
flask,  before  the  investment  in  this  flask  gets  hot  enough  to  dis- 
tort the  mold,  and  this  means  that  it  must  have  an  oxyhydrogen 
or  nitrous  oxide  blowpipe.  It  must  furnish  me  with  a  means 
to  definitely  know  how  much  pressure  I  am  using  for  casting, 
and  I  must  be  enabled  to  sustain  that  pressure  at  will;  and  I 
must  be  enabled  to  apply  that  pressure  at  the  psychologic  mo- 
ment. 

These  things  a  pressure  machine  must  do  or  it  will  be  use- 
less. What  other  things  it  may  do  in  addition  to  those  men- 
tioned, are  a  matter  of  refinement  of  detail  and  economy  of 
operation,  and  are  of  course  factors  which  determine  one  in 
the  purchase  of  any  merchandise,  but  they  are  not  absolute 


CASTIXt;     MOLTKX     M  KTAL  —  .M  ACI !  I  X  KS    K.MI'LOVKD  1!).") 

essentials   to  perfect   results  while  the  first  mentioned  things 
are  al)solntely  so. 

Now,  before  taking  up  direct  pressure  machines,  suppose 
we  quickly,  but  thoroughly,  consider  some  of  the  phenomena 
which  take  place  in  the  casting  of  gold  under  pressure. 

The  following  is  a  quotation  in  part  from  a  treatise  written 
by  ('.  J.  Clark,  of  Chicago,  Illinois. 

"  Kor  countless  ages  the  matter  of  the  earth  existed  in  a 
molten  state,  gradually  cooling  and  shrinking  until  the  surface 
became  ridged  and  the  internal  molten  mass  became  encapsuled 
by  a  crust.  As  the  shrinkage  continued,  matter  was  called  upon 
to  supply  the  deficiency,  and  the  crust  being  solid  and  rigid, 
and  held  by  the  power  of  cohesion,  the  power  of  the  centrifugal 
force  was  the  greatest  at  the  greatest  circumference,  and,  of 
course,  the  portion  of  the  revolving  sphere  that  offered  the 
least  resistance  (the  poles)  succumbed  to  the  demands  of  the 
internal  shrinkage  and  were  drawn  inward;  and  so  we  find  the 
earth  flattened  at  the  poles. 

"The  cooling  of  a  metal  in  a  mold,  while  not  exactly  similar, 
is  strikingly  analogous  to  the  cooling  of  a  planet  or  the  earth 
on  which  we  live. 

".Matter  is  never  at  rest,  the  atoms  comprising  the  mole- 
cules revolving  around  a  common  center,  forming  a  miniature 
solar  system,  are  in  a  constant  state  of  agitation,  moving  rapidly 
around  in  their  medium  in  ether,  and  confined  in  their  move- 
ment to  their  limited  space  between  their  fellows. 

••'///c  (>nf<T  surface  of  a  mass  of  matter  is  the  first  to  be 
susceptible  to  any  thermal  change,  the  effect  being  transmitted 
to  the  center,  and  if  this  thermal  change  of  sufficiently  liigh 
degree  to  change  the  state  of  the  mass  from  the  solid  to  the 
liquid,  or  gaseous,  or  vice  versa,  the  surplus  is  the  first  to  exhibit 
these  manifestations. 

"Let  us  suppose  a  cross  section  of  a  gold  plate  is  being  sub- 
jected to  heat  of  sufficient  degree  to  induce  a  change  in  its 
physical  structure,  the  atoms  of  the  molecules  revolve  more  rap- 
idly than  before,  become  more  diverging  in  their  tendency,  de- 
scribing a  large  circumference  about  their  common  center,  the 
molecules  increase  in  the  same  proportionate  volume,  and  their 
mutual  power  of  cohesion  diminishes.  This  allows  the  mole- 


CAST    COLD    AND    POKCKLAIX    1X1  AYS 

cules  to  separate  more  widely,  and  permits  of  a  greater  latitude 
in  which  to  exercise  their  mobility.  As  the  atoms  are  whirling 
about  their  common  center,  the  molecules  are  revolving  and 
revolving  also  about  each  other,  generating  centrifugal  force 
to  such  an  extent  as  to  overcome  the  force  of  gravity,  and  with 
a  tendency  towards  projection  in  every  direction  held  in  re- 
straint only  by  the  still  active  though  much  weakened  power 
of  cohesion. 

"This  causes  some  molecules  to  be  lifted  above  their  fel- 
lows, and  as  the  heat  increases,  the  mass  begins  to  assume  a 
globular  shape  or  form  and  presents  a  panorama  of  rhythmic 
harmonious  action. 

"Now  if  the  heat  be  withdrawn,  the  revolutions  of  the  atoms 
about  their  common  centers  decrease,  and  as  their  momentum 
gradually  diminishes,  the  atoms  come  into  closer  proximity,  the 
molecules  decrease  in  volume,  the  power  of  cohesion  increases, 
the  mutual  attraction  of  the  molecules  becomes  more  intense, 
exhibiting  more  influence  than  the  force  of  gravitation,  and  the 
congealing  mass  of  metal  retains  more  or  less  of  the  globular 
form,  the  molecules  being  caught  on  the  act  of  falling,  much  the 
same  as  wTater  is  caught,  and  held  in  the  formation  of  an  icicle. 

"The  duration  of  time  in  which  the  metal  is  transformed 
from  a  molten  to  a  solid  state  is  exceedingly  short,  and  the  fact 
that  the  metal  retains  enough  heat  to  maintain  a  red  color  for 
a  time,  furnishes  no  scientific  proof  that  the  metal  in  the  mold 
will  shrink  for  the  metal  that  remains  in  the  crucible  and  the 
metal  in  the  mold  encounter  conditions  in  hardening  which  are 
diametrically  opposed.  The  metal  in  the  crucible  is  confined  by 
no  walls,  and  the  pressure  on  it  being  from  without  inward,  has 
no  such  effect,  as  on  that  confined  in  the  mold,  for  the  reason 
that  the  hydraulic  pressure  that  the  confined  gold  is  subjected 
to,  forces  the  metal  from  the  center,  outwardly  as  long  as  it 
remains  molten,  and  thus  it  is  pressed  against  the  cooler  walls 
where  the  crust  as  described  is  formed,  and  which  will  register 
a  density  of  19.45  against  19.16  of  that  remaining  in  the  crucible; 
and  there  is  no  inherent  force  or  physical  property  in  the  metal 
itself  after  being  cast  under  pressure  capable  of  suggesting  its 
density  to  any  further  degree. 

"So  it  is  physically  impossible  for  it  to  shrink  to  any  appre- 


CASTIXC     .MOLTKX    M  KTAL MACIIIXKS    KM  !'].( >VKD  1  97 

ciable  degree,  therefore,  if,  in  the  process  of  making  an  inlay 
or  a  more  extended  piece  by  casting  under  pressure,  any  dis- 
tortion occurs,  or  it  is  not  a  facsimile  of  the  wax  model,  the  dis- 
crepancy must  he  ascribed  to  some  other  factor  or  cause  than 
the  shrinking  of  the  gold  alone. 

"If  this  globule  of  gold  were  measured  for  its  specific  grav- 
ity, it  would  be  found  that  it  developed  by  the  mutual  attrac- 
tion of  its  molecules  (cohesion),  a  density  that  registers  a 
relative  specific  gravity  of  19.16. 

"Thus,  if  gold,  heated  so  as  to  assume  the  liquid  state,  be 
allowed  to  congeal  uninfluenced  by  any  interfering  conditions, 
the  only  factors  entering  into  the  phenomena  being  mass,  co- 
hesion, heat,  molecular  mobility,  volume  and  gravitation,  it  is 
a  physical  possibility  for  the  metal  to  develop,  by  virtue  of  its 
cohesive  force,  a  density  that  registers  a  relative  specific  grav- 
ity above  19.1(i.  In  tin-  caxtitif/  of  metal  under  pressure,  addi- 
tional factor*  enter,  and  nmst  he  taken  into  consideration;  thei/ 
are  hydraulic  pressure  and  ireldinfi,  the  latter  bc'nuj  induced  by 
/l/e  force  of  hydraulic  pressure. 

"If  a  mold  has  been  prepared  in  the  usual  procedure  for 
a  cast  under  pressure,  and  is  in  a  condition  for  the  reception  of 
the  molten  metal,  a  button  of  gold  fused  in  the  crucible  mani- 
fests the  same  physical  phenomena  previously  described.  The 
atoms  will  revolve  around  their  common  center  more  rapidly 
than  at  a  lower  temperature,  and  the  molecules  will  revolve 
around  each  other  in  like  manner,  and  the  metal  is  gradually 
transformed  from  the  solid  to  the  molten  or  the  liquid  state. 
If  force  now  be  suddenly  applied  to  the  liquid  mass  in  the  cru- 
cible, a  portion  of  it  will  be  forced  by  displacement  into  the 
mold,  and  if  the  pressure  be  maintained  for  a  time  it  will  be 
transmitted  from  molecule  to  molecule,  simultaneously  in  every 
conceivable  direction,  the  hydraulic  force  pressing  the  mole- 
cules to  all  surfaces  and  angles  of  the  mold.  As  the  molecules 
at  tiie  surface  of  the  mass  come  in  sudden  contact  with  the  walls 
of  the  mold,  their  movements  are  abruptly  checked,  the  atoms 
of  the  molecules  are  forced  to  closer  proximity,  the  molecules 
decrease  in  volume  and  have  less  latitude  in  which  to  exercise 
their  mobility,  which  instantly  induces  congealation;  and  as  they 
are  held  firmly  against  the  walls  of  the  mold,  gaps  and  crevices 


198  CAST  GOLD  AND  PORCELAIN  INLAYS 

occur,  which  are,  however,  filled  by  the  pressure  behind,  and 
with  inconceivable  rapidity,  with  new  recruits,  frenzied  and 
heat  maddened,  where  they  meet  the  same  fate  as  their  fellows, 
crushed  and  jammed  against  each  other  and  the  walls  of  the 
mold  until  in  congealing  a  rigid  wall  or  capsule  lines  every  sur- 
face and  angle  of  the  mold. 

''This  goes  on  in  the  same  way  until  the  surface  crust  thick- 
ens to  the  center,  all  following  the  same  regular  order  of  things, 
but  with  no  loss  of  appreciable  time  in  a  small  mass  of  gold  as 
might  be  inferred  from  the  deliberate  description.  This  metal 
will  be  found  to  be  of  higher  specific  gravity  than  when  it  is 
allowed  to  cool  under  ordinary  conditions." 

Here  then  we  have  a  quotation  from  a  treatise  written  by 
one  who  used  as  a  guide  and  reference  nearly  every  known  au- 
thority on  the  subject,  and  here  too,  we  find  as  a  result  of  his 
inquest  into  the  mystery,  the  definite  statement  that  in  casting- 
gold  under  pressure  the  part  entering  the  mold  is  the  first  to 
congeal.  A  statement  which  not  only  emphatically  but  most 
effectually  contradicts  the  assertion  of  an  extoller  of  the  virtues 
of  the  vacuum  process,  that  only  with  this  machine  does  the 
hardening  of  the  mass  in  the  mold  take  place  before  the  harden- 
ing of  the  mass  in  the  crucible. 

As  a  matter  of  fact,  in  all  casting  of  high-fusing  metal,  with 
the  aid  of  any  pressure  exerted  upon  the  molten  mass  by  any 
special  apparatus,  the  surplus  in  the  crucible  is  the  very  last 
to  congeal  or  crystallize,  and  that  part  entering  the  mold  is  the 
first  to  assume  an  unalterable  shape. 

Since  the  invention  of  pressure  casting  as  applied  to  den- 
tistry, dozens  of  pressure  casting  machines  have  been  offered 
to  the  profession  and  each  one  was,  according  to  the  literature 
of  the  maker,  the  best  for  the  purpose.  There  is  the  LeCrone, 
the  Cleveland  Dental,  the  simple  little  swage,  the  Sure  Cast, 
the  Simplex,  the  Seymour,  in  fact  there  are  so  many,  that  the 
number  would  compare  favorably  with  the  number  of  different 
makes  of  automobiles,  and  like  automobiles,  they  would  all  go 
for  a  time,  and  after  a  fashion.  All  can  puff  and  snort,  and 
make  a  noise.  The  point  of  interest  to  the  profession  is,  that 
these  machines  ultimately  differ  widely  in  the  result  that  one 
can  accomplish  with  them. 


CASTING    MOLTEN    METAL MACHINES    EMPLOYED  199 

Sonic  of  the  pressure  machines  mentioned  supply  the  nec- 
essary force,  by  feeding  compressed  air  through  a  chamber  which 
opens  onto  and  above  the  molten  mass;  others  simply  allow  a 
little  chamber  filled  with  a  moist  compressible  substance  to  be 
placed  over  the  crucible  which  contained  the  molten  metal,  the 
heat  of  this  metal,  acting  upon  the  moisture  contained  in  the 
above  substance  would  convert  this  moisture  into  steam,  and 
this  steam  would  supply  the  pressure  necessary  to  propel  the 
metal  into  the  mold. 

The  most  reliable  of  these  is  one  called  the  Solbrig  machine 
and  is  marketed  here  by  Ash  &  Sons.  Were  this  machine  sup- 
plied with  a  means  for  definitely  controlling  and  measuring  the 
pressure,  it  would  prove  a  valuable  appliance  in  one's  labora- 
tory, and  be  quite  suitable  for  inlay  work.  As  it  stands  today, 
it  may  be  used  only  for  casting  that  requires  no  definition  of 
fine  lines,  angles,  or  margins,  where  microscopic  accuracy  in 
reproduction  of  those  lines,  angles,  and  margins  is  not  an  essen- 
tial factor.  I  know  of  no  inlay  that  will  permit  of  such  devia- 
tion, and  still  be  fit  for  use  for  any  cavity  in  any  tooth.  A  brief 
description  of  this  machine  will  suffice.  , 

It  consists  of  the  base,  upon  which  the  flask  containing  the 
mold  rests.  This  flask  is  received  in  a  shallow  ring  upon  the 
base.  A  rigid  support  rises  from  the  base,  and  to  this  support 
a  movable  arm  carrying  an  adjustable  metal  cover,  is  connected. 
This  adjustable  metal  cover  fits  loosely  over  the  flask.  When 
the  wax  pattern  lias  been  burned  out  of  the  mold,  the  flask  is 
placed  into  the  ring  upon  the  base,  and  an  asbestos  disc,  satu- 
rated with  water,  is  placed  into  the  cover.  The  gold  is  put  into 
the  crucible  in  the  mold,  and  is  brought  to  a  boiling  point;  the 
movable  arm,  carrying  the  adjustable  cover  is  brought  down- 
ward onto  the  flask  containing  the  molten  metal,  and  held  there 
for  a  minute,  when  the  casting  is  completed.  The  heat  of  the 
metal  converts  the  water  in  the  asbestos  disc  into  steam,  and 
this  steam,  confined  in  the  small  area,  induces  a  tremendous 
pressure  upon  the  molten  mass;  just  what  effect  all  this  pres- 
sure may  have  on  this  mold  is  a  matter  which  may  be  calculated 
by  taking  the  resistance  and  the  amount  of  the  pressure  under 
consideration.  Absolutely  definite  results  are  impossible  with 
this  machine  because  the  pressure  is  uncontrolled  and  can  not 


200  CAST    GOLD    AND    PORCELAIN     INLAYS 

be  definitely  and  measurably  modified.  AVe  do  not  need  a  ton 
of  dynamite  to  blast  a  pebble  out  of  the  sandy  beach. 

The  machine  I  use  for  the  casting  of  gold  inlays  is  a  direct 
pressure  machine,  invented  and  built  for  this  purpose  by  the 
inventor  of  the  process.  It  is  a  machine  which  enables  one  to 
bring  the  gold  to  a  boiling  point  in  the  crucible  of  the  flask 
before  the  entire  mold  has  been  heated  to  a  point  of  distortion. 
It  makes  possible  the  use  of  a  small  nitrous  oxide  flame,  and  it 
gives  off  an  infinitely  greater  amount  of  heat  concentrated  on 
the  bottom  of  the  metal,  than  can  be  obtained  with  a  large  blast 
flame  of  the  ordinary  blowpipe.  It  is  a  machine  which  enables 
a  man  to  apply  a  measured  amount  of  perfectly  sustained  pres- 
sure at  the  very  moment  when  he  realizes  that  he  must  have 
this  pressure,  and  the  flame  is  automatically  turned  off  as  the 
pressure  is  applied. 

I  use  this  machine  in  conjunction  with  the  entire  technic, 
because  it  enales  me  to  do  my  ivork  of  restoration  in  such  a. 
manner  as  to  make  the  probability  of  recurrent  requirement  for 
further  effort  in  that  direction  very  remote,  if  not  altoyther 
impossible. 

This  is  what  the  cast  gold  inlay,  conceived  and  made  avail- 
able for  public  use  by  the  discoverer,  will  do,  if  we  are  careful 
to  follow  the  directions  in  every  step  of  the  procedure. 

It  is  essential  for  him  who  would  practice  gold  inlay  work 
correctly  to  consider  the  entire  technic  as  a  complete  circum- 
ference of  a  circle,  presenting  no  break  in  its  continuity.  In  the 
center  of  that  circle  and  responsible  for  this  unbroken  circum- 
ference is  the  ideal  which  the  inventor  conceived  and  held  onto 
while  he  thoroughly  and  carefully  worked  out  every  phase  of 
this  technic. 

There  can  be  no  question  upon  the  statement  that  all  of 
this  revolutionizing  principle  had  its  inception  in,  first,  a  vivid 
realization  that  present  methods  were  inefficient  to  stem  the 
tide  of  tooth  destruction;  and,  second,  in  the  birth  of  the  ideal 
of  what  should  be  done  in  order  to  effectually  stem  this  tide. 
If  we  place  this  ideal  in  the  center  of  this  circle,  and  now  divide 
our  circumference  into  its  360  degrees,  and  run  a  radius  from 
each  degree  upon  the  circumference  to  the  center,  we  shall  be 
in  a  better  position  to  understand  just  how  closely  dependent 


CASTINd     MOLTKN    MKTAL — MAC' H  INKS    K.M  I'LOYKI) 


201 


upon   this   conceived   ideal   lias   been   and   must   be   the   entire 
technic. 

Indexed,  with  the  ideal  already  fixed  in  the  mind  of  the  in- 
ventor, it  became  only  a  question  of  time  as  to  when  the  enor- 
mous amount  of  mental  activity  playing  around  this  ideal,  would 
manifest  itself  in  the  expenditure  of  physical  effort  which  would 


Fig.  171. — Taggart  machine  with  flask  in  position  on  its  base.  Charcoal 
block  and  nitrous  oxide  flame  playing  upon  a  button  of  gold.  T.o  the  right  is  a 
l:ir^f  box  containing  a  mixture  of  potassium  nitrate  and  borax.  The  gauge  upon 
the  Taggart  machine  indicates  five  pounds  of  pressure. 

in  time  create  in  actual  physical  form  what  already  existed  in 
the  abstract,  but,  nevertheless,  causative,  ideal  of  it.  And  so 
this  ideal,  powerful,  ivreat  and  beneficent,  and  with  the  approval 
of  all  cosmic  laws  to  aid  it,  occupies  the  central  throne  and  be- 
gins to  throw  out  its  elements  of  physical  manifestation  as 


202 


CAST  GOLD  AND  PORCELAIN  INLAYS 


radii  of  a  circle.  One  element  is  the  wax,  and  we  see  this  grow 
from  an  obscure  indefinite  point  to  a  clearly  determined  actual- 
ity; another  element  is  the  compound,  going  through  the  same 


Fig.  172. — The  Taggart  machine  raised  to  permit  the  use  of  a  number  of 
sizes  of  larger  flasks  designed  by  the  author  to  enable  him  to  make  larger  castings 
for  extensive  cases  of  restoration  requiring  large  saddles  for  removable  bridge 
dentures. 


cycle  of  experience;  then  came  the  crucible,  its  depth,  its  width, 
and  curvature  of  its  arc,  and  the  relation  of  this  depth  to  this 
width  and  curve,  and  the  sprue,  the  length  of  that  and  the  re- 


CASTIXC    MOI.TKX     MKTAI. .MACHINES    EMPLOYED 

hit  ion  of  tlie  length  of  that  to  the  pattern  \vitliin  the  mold;  and 
the  ilask.  the  height  and  the  width  and  the  circumference  of 
that;  and  the  relation  of  these  to  tin*  curve  and  the  depth  and 
width  of  the  crucible  and  the  pattern  within  the  mold;  the  mixer 
and  the  heater;  the  blowpipe  and  the  mixing  chamber  for  the 
ga>i  s;  the  regulating  of  the  pressure  as  to  increase  and  de- 
crease, and  the  sustaining  of  the  pressure  thus  obtained;  and 
the  machine  as  a  whole. 

The  hundreds  upon  hundreds  of  questions  which  were 
found  and  had  to  be  solved,  and  were  solved,  not  only  as  indi- 
vidual problems,  but  as  prohh  ms  related  each  to  the  other  which 
came  before,  and  the  one  which  was  to  follow;  so  this  work 
went  on  until  this  ideal,  sitting,  so  to  speak,  in  the  center  of  our 
abstract  circle,  had  sent  out  these  radii  toward  every  degree 
upon  the  circumference,  and  behold!  the  task  was  complete. 
Here  is  a  process  so  perfect  that  not  a  weak  point  can  he  found 
in  it,  and  here  too,  is  a  machine  so  perfect,  and  accessories  so 
unique,  that  all  intcrplayed  perfectly  with  each  other  to  call 
forth  a  perfect  result,  provided  all  of  it,  the  process,  the  ma- 
chine, and  the  accessories,  are  well  understood  and  properly 
handled. 

It  is  not  to  be  marveled  at  that  the  idea  of  cast  gold  inlays 
swept  the  profession  clean  off  its  feet  into  a  frenzy  of  hopeful 
enthusiasm.  Here  at  last  was  the  possibility  of  doing  the  right 
kind  of  restorative  work,  and  blind  indeed  we  should  have  been 
had  we  failed  to  recognize  it.  Here  were  possibilities  so  preg- 
nant with  hope  for  the  betterment  of  the  race,  dentally  con- 
sidered, so  potent  in  effect  upon  the  future  of  their  well  being 
that  it  set  med  as  if  the  glory  of  truth  had  at  last  broken  through 
the  meshwork  of  inefficient  and  often  misleading  dogma. 

The  profession  saw  it  and  gasped  at  the  one  stupendous 
stride  that  would  make  creators  out  of  them  in  place  of 
menders. 

They  who  followed  implicitly  all  the  directions,  bent  every 
effort  to  carry  out  minutely  every  detail  of  the  technic,  who 
studied  and  understood  the  machine  by  itself,  and  in  relation 
to  every  step  which  accompanies  the  use  of  all  the  carefully 
planned  accessories,  have  been  rewarded  beyond  their  own 
hopes  and  dreams.  They  have  seen  a  new  era  rise  in  dental 


204 


CAST  GOLD  AND  PORCELAIN  1XLA\S 


service  and  dental  accomplishment,  and  with  the  use  of  the 
process,  their  love  for  the  work  has  grown  and  with  the  growth 
of  their  love  for  the  work,  the  standard  of  their  work  has  been 
raised.  Dentistry  to  them  is  no  more  a  mere  profession,  a 
trade,  a  means  of  a  livelihood.  It  is  a  religion  to  be  cherished 
and  throughly  studied  for  the  good  it  will  bring  to  humanity; 
for  the  aid  it  will  bring  to  struggling  man,  in  his  efforts  to 
evolve  into  a  perfect  being.  That  is  what  dentistry  means  to 
them;  not  one  of  them  but  will  affirm  and  add  to  this  declaration. 


Fig.  173. — To  the  right  is  a  view  of  a  small  Taggart  flask  and  its  crucible 
former  which  holds  the  sprue  wire.  To  the  left  is  the  author's  barrel-shaped  flask 
and  its  crucible  former  and  the  shortened  sprue  wire.  The  amount  of  refractory 
compound  surrounding  the  wax  pattern  is  more  nearly  equal  in  bulk  in  all  direc- 
tions in  the  barrel-shaped  flask. 


Fig.  174. — A  special  flask,  barrel-shaped,  made  by  the  author  in  two  sections 
to  be  used  for  large  castings.  The  Taggart  machine  that  takes  this  flask  has  been 
raised  from  its  platform  sufficiently  to  provide  the  necessary  room. 

Is  not  such  an  experience  an  incentive  to  every  student, 
and  every  dentist  who  has  not  yet  done  so,  to  take  up  this 
process  and  study  it,  and  persevere  and  follow  instructions  until 
it  has  been  mastered  ! 

The  use  of  this  machine  is  exceedingly  simple.  It  is  a  ques- 
tion of  knowing  what  is  wanted,  of  knowing  that  the  machine 
will  do  all  it  is  intended  for,  and  of  testing  the  machine  before 
each  casting  to  make  sure  that  all  is  in  order. 


CASTING    MOLTKN    MKTAL MACI I  I  X  KS    KM  IM.(  )VKI)  I'D.") 

Upon  examination  of  the  flasks  designed  by  Dr.  Taggart, 
it  will  lx»  noticed  that  each  one  contains  a  small  hole  about  the 
si/o  of  11 -gauge  wire.  This  serves  two  purposes;  it  forms  a 
vent  to  facilitate  the  escape  of  any  gas  or  air  which  may  be 
present  at  the  time  of  casting,  and  which  might  offer  a  resist- 
ance to  the  ingress  of  the  metal;  and  it  serves  to  show  how 
well  or  how  poorly  the  pressure  gas  may  be  flowing  through 
the  vertical  cylinder  into  the  pressure  plate,  and  from  there 
onto  the  metal. 

Test  the  machine  out  as  follows: 

Place  a  piece  of  rubber  dam  into  the  small  base  of  the  ma- 
chine, and  seat  the  llask  roundside  up  into  this  base;  open  the 
valve  on  the  nitrous  oxide  cylinder,  and  by  means  of  the  reduc- 
ing valve,  regulate  the  pressure  to  the  desired  point.  (Three 
to  five  pounds  pressure  is  the  right  amount  for  casting  inlays.) 

See  that  the  packing  in  the  pressure  head  is  not  dried  out 
and  leaky,  and  see  that  the  four  small  holes  which  allow  the 
gas  to  pass  through  down  onto  the  flask,  are  free  from  any 
metal  or  other  obstruction. 

Now  bring  the  arm  or  lever  of  the  machine  forward  down 
upon  the  flask  while  you  hold  the  fingers  of  the  other  hand 
around  the  flask  so  as  to  close  the  hole  at  the  upper  part  of  it. 

The  bringing  forward  and  downward  of  the  lever  will  throw 
a  valve  inside  of  the  vertical  cylinder  which  will  cause  the 
nitrous  oxide  to  descend  through  it.  If  you  feel  the  pressure  of 
the  descending  gas  upon  your  finger,  which  closes  the  hole  in 
the  flask,  the  machine  is  in  good  shape  and  fit  to  be  cast  with. 
Now  alternately  remove  and  replace  your  finger  over  the  flask 
opening;  the  hand  upon  the  pressure  gauge  should  keep  time 
with  your  actions,  that  is,  it  should  drop  to  zero  as  you  remove 
your  finger,  and  reascend  to  three  or  five  pounds  as  you  close 
the  opening. 

This  will  show  the  perfect  condition  of  the  machine,  and 
you  may  rely  upon  it  for  the  sustained  pressure  required  for 
successful  casting. 

Xo\v  release  the  lever  arm  and  remove  the  empty  flask,  sub- 
stituting for  it  the  flask  containing  the  mold  ready  for  casting. 
Turn  the  blowpipe  until  it  is  at  right  angles  to  the  machine,  and 
ignite  the  city  gas,  opening  the  city  gas  valve  until  you  have  a 


206  CAST    GOLD    AXD    PORCELAIN    ]X FAYS 

llame  about  four  inches  long.  Xow  place  a  button  of  clean  gold 
24  carat  fine,  (be  sure  it  is  clean)  into  a  charcoal  crucible  placed 
near  the  flask  (put  on  brown  or  blue  glasses)  and  open  the 
needle  valve  on  the  regulator,  which  will  allow  the  nitrous  oxide 
to  flow  into  the  mixing  chamber,  through  which  the  city  gas  is 
flowing.  The  mixing  of  the  two  gases  will  produce  a  very  hot 
blue  flame  about  three-quarters  of  an  inch  long,  and  th.i.s  flame 
is  directed  upon  the  button  of  gold  by  turning  the  blowpipe 
downward  directly  over  it. 

In  about  thirty  to  sixty  seconds,  varying  with  the  amount 
of  gold,  the  flame  will  have  brought  the  metal  almost  to  the 
fusing  point.  Remove  the  heated  gold  to  the  crucible  in  the 
flask  and  play  the  flame  upon  it.  The  tendency  of  the  mass  to 
assume  a  spheroidal  shape  will  now  appear,  and  finally  the 
molten  metal  will  present  a  glowing  shape  and  the  mass  will 
be  seen  to  move.  The  gold  may  now  be  called  fluid,  but  it  is 
not  yet  hot  enough  for  casting.  If  it  were  cast  at  this  moment 
a  very  sluggish  mass  would  have  to  be  dealt  with,  and  a  very 
imperfect  piece  of  work  would  be  the  result. 

This  may  be  avoided  by  keeping  the  flame  upon  the  fluid 
gold  until  the  heat  of  it  has  been  raised  to  such  a  point  that 
the  molecules  seem  to  repel  one  another  violently.  The  molten 
mass  will  assume  the  color  of  sunlight,  with  a  violet  tint  in  it, 
the  mass  will  not  move  from  side  to  side  but  will  rise  in  the 
crucible,  as  if  pushed  up  from  beneath,  only  to  drop  back  again 
to  repeat  the  performance. 

All  this  has  taken  less  than  a  minute  and  at  this  stage  the 
lever  is  brought  smartly  forward;  the  plunger  and  pressure 
heads  descend  upon  the  flask,  the  blowpipe  is  thrown  to  one 
side,  the  city  gas  is  shut  off,  the  valve  which  allows  the  pressure 
gas  to  descend  upon  the  molten  metal  is  thrown  open,  as  the 
flask  is  sealed,  and  the  molten  metal  is  forced  into  the  mold  and 
held  there  under  a  constant  and  sustained  pressure. 

The  nitrous  oxide,  previously  used  to  aid  in  melting  the 
metal,  backs  up  and  reenters  the  descending  valve  to  spend  its 
force  or  pressure  upon  the  congealing  mass. 

It  is  unnecessary  to  again  enumerate  all  the  curious  molec- 
ular movements  and  atomic  agitations  which  take  place  on  cast- 
ing. At  best,  they  are  theoretic  consideration,  beautifully 


CASTIXC     MOLTKX    MKTAL MACIIIXKS    KMI'LOYKI)  207 

reasoned  out;  but  for  the  man  doing  the  practical  work  as  out- 
lined heroin,  they  need  carry  no  further  importance,  except  to 
inform  him  of  what  actually  takes  place. 

From  forty  seconds  to  a  full  minute's  time  should  be  given 
for  the  gas  to  exercise  its  pressure  against  the  congealing  metal. 
The  level-  may  then  be  released  by  pulling  the  spring-actuated 
pin  on  the  upper  part  of  the  machine-head  forward.  The  lever 
is  then  thrown  back,  and  will  carry  the  pressure  head  upward. 
The  Mask  will,  in  most  instances,  be  found  cool  enough  to  grasp 
with  the  hand,  illustrating  how  little  actual  and  distorting  heat 
entered  the  mold  during  the  melting  of  the  metal. 

1 1'  he  Mask  be  uncomfortably  warm,  it  may  be  grasped  with 
the  llnsk  forceps,  and  either  thrown  into  a  bowl  of  water,  or  held 
under  the  cold  water  faucet,  until  the  mold  disintegrates  and 
is  washed  off.  A  stiff  toothbrush  will  remove  most  of  the  com- 
pound around  the  inlay  and  surplus,  and  we  shall  find  the  cast- 
ing complete. 


REFERENCE  CONSULTED  ON  THE  EXPANSION  AND  CONTRACTION 

OF  METALS 

Clark,  D.  K. :     A  Manual  of  Rules,  Tables  and  Data  for  Mechanical  Engineers, 

1878,   *K598. 

Dana,  E.  S.:     Editorial,  Am.  Jour.  Sc.  and  Arts,  1901,  vol.  clxi. 
DuBois,  A.  J.:     Elementary  Principles  of  Mechanics,  1894,  vol.  ii,  K4982.2. 
Howe,  H.  M.:     Metallurgical  Laboratory  Notes,  1902,  K12780. 
Hutton,  W.  S.:     Practical  Engineer's  Handbook,  1896,  K5405. 
Lineham,  W.  J.:     Text-book  of  Mechanical  Engineering,  1894,  K4958. 
Poynting,  J.  H.,  and  Thompson,  J.  J. :     Text-book  of  Physics,  1904,  K15930.3. 
Rankine,  W.  J.  M.:     Manual  of  Civil  Engineering,  1891,  K661. 
Tlmrstmi,  R.  H. :      Brasses,  Bvoux.es,  and  Other  Alloys,  1900,  KJ5502.3. 
Useful  Rules  and  Tables,  1873,  K665. 
Watson,  W.:     Text-book  of  Physics,  1905,  K15933. 


SUMMARY  FOR  CHAPTER  XIV 
The  Casting  of  the  Molten  Metal  Into  the  Mold 

1.  Describe  the  part  played  by  temperature  in  the  inlay  technic  up  to  the  point 
of  drying  out. 

2.  What  happens  when  the  flask  is  heated?     What  effect  on  the  mold  has 
the  proximity  of  the  flask  to  it? 

3.  What  is  the  result  of  casting  into  a  hot  mold? 

4.  Why    is    a    cold    flask   necessary    and    how    does   it    follow    the   temperature 
sequence? 


1208  CAST    GOLD    AXD    PORCELAIN    IX LAYS 

The  Casting  of  Metal  into  the  Mold  and  a  Consideration  of  the  Various  Machines 

Employed 

1.  What   is   the   principal   objection   to   the   use   of   a    casting   appliance    in- 
volving centrifugal  force! 

2.  Give  the  reasons  for  and  against  the  choice  of  a  vacuum  machine. 

3.  What  are  the  essentials  of  a  casting  machine  involving  direct  pressure? 

4.  How    would    you    prevent    the    distortion    of    the    mold    during    the    actual 
casting  ,of  the  inlay? 

5.  Describe  the  tcchnic  of  casting  in  a  Taggart  machine. 


CHAPTER  XV 

THE  CLEANSING  OF  THE  CASTING  IN  HYDRO- 
FLUORIC ACID  AND  IN  A  SODIUM 
BICARBONATE  BATH 

After  the  casting  lias  been  carefully  and  thoroughly  brushed 
free  from  compound,  it  is  placed  in  a  rubber  cup  containing 
hydrofluoric  acid.  The  acid  will  free  the  casting  from  any  of 
the  silicate  it  may  still  have  on  it.  It  would  be  impossible 
to  remove  every  evidence  of  this  by  the  use  of  the  brush  only. 
Owing  to  the  enormous  amount  of  heat  to  which  the  metal  is 
subjected  under  the  nitrous  oxide  flame,  it  picks  up  a  number 
of  mineral  and  metallic  impurities,  which,  however,  are  finally 
forced  to  the  surface  of  the  casting  and  the  crucible  side  of  the 
surplus.  Particularly  does  the  crucible  side  of  the  surplus  but- 
ton become  contaminated  with  interfering  agents  which  it  picks 
up  from  the  silica,  and  for  this  reason  it  is  advisable  (impera- 
tive is  the  word)  not  to  use  any  gold  for  casting  unless  it  is 
absolutely  clean. 

It  is  best  to  take  these  surplus  buttons  and  define  them  be- 
fore using  them  again.  More  of  this  later. 

When  the  casting  has  been  in  the  acid  at  least  several  hours 
(it  is  sometimes  best  to  leave  it  in  overnight),  the  cover  is 
removed  from  the  hard  rubber  acid  cup,  and  the  casting  is  taken 
out  with  a  pair  of  tweezers  and  washed,  under  the  faucet,  then 
brushed  with  soap  and  water. 

A  test  tube  about  six  inches  long  and  three-quarters  of  an 
inch  in  diameter,  is  filled  about  one-third  of  its  capacity  with 
a  saturated  solution  of  sodium  bicarbonate,  and  the  casting  is 
boiled  in  this  solution  until  every  trace  of  the  acid  has  been 
neutralized. 

It  is  important  that  the  acid  be  neutralized  beyond  a  doubt 
because  of  the  deleterious  effect  of  the  least  particle  of  this  acid 
upon  any  cement  or  tooth  structure. 

209 


210 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Rubber  and  metal,  and  the  waxes,  seem  to  be  tli  eonly  sub- 
stances which  are  not  attacked  by  it;  hence  the  use  of  the  rubber 
cup  as  a  receptacle  for  it.  1  bought  a  hard  rubber  cup  about 
four  inches  high,  two  and  one-half  inches  in  diameter  at  the 
mouth,  and  about  one  and  three-fourths  indies  in  diameter  at 
the  bottom.  It  is  an  ordinary  hard  rubber  drinking  cup  and 
may  be  bought  at  any  rubber  goods  shop  or  large  drug  store. 
This  is  used  for  the  hydrofluoric  acid. 


Fig.   175. — Acid   cup,   support,   and   stopper    for   hydrofluoric   acid,      a,   stopper;    6, 
tapering   hard  rubber  cup;    c,  piaster  of  Paris  block   carrying   cups. 

A  batch  of  plaster  of  Paris  was  mixed  to  a  creamy  con- 
sistency and  poured  into  a  paper  box  four  inches  square.  Into 
this  mix  of  plaster,  the  moistened  rubber  cup  was  forced  to 
within  one-half  inch  of  the  bottom  of  the  box  containing  the 
plaster,  and  the  mass  containing  the  cup  was  allowed  to  set. 

The  next  day  the  paper  was  removed,  and  the  surface  of 


CI.KAXSIXt;    TIIK    CASTlXd  Llll 

the  plaster  was  trimmed  to  a  sightly  aj>])<  arance.  After  several 
days  the  mass  had  thoroughly  hardened  and  shrunk  because  of 
the  cone-shape  of  the  cup,  and  was  expelled  from  its  scat. 

A  quantity  of  stearine  was  allowed  to  come  to  a  boil  in  an 
agateware  vessel,  and  the  plaster  form  was  put  into  it  and  al- 
lowed to  boil  for  one  and  one-half  hours.  The  result  was  a  plas- 
ter receptacle,  hard  and  smooth,  into  which  the  cup  could  be 
placed,  and  which  form  it  was  practically  impossible  to  upset. 

AYhen  the  cup  was  put  into  the  seat,  it  was  turned  toward 
the  right  and  was  made  to  fit  very  snugly.  About  one-third 
of  the  cup  extends  beyond  and  out  of  the  plaster,  so  that  it  may 
be  easily  grasped  and  turned  to  the  left  for  the  purpose  of 
unseating  it. 

A  block  of  wood  was  shaped  to  loosely  fit  the  mouth  of  the 
cup,  and  into  the  center  of  this  block  and  going  half  way  through 
it,  a  small  brass  eye  was  inserted  to  serve  as  a  handle. 

A  layer  of  paraffine  about  one-eighth  of  an  inch  was  placed 
over  every  part  of  this  block,  and  it  was  again  fitted  into  the 
cup.  While  it  was  seated,  more  paraffine  was  added  to  the 
circumference  of  the  block,  and  this  paraffine  was  allowed  to 
overlap  the  cup,  thus  producing  a  cover  which  fitted  into  and 
over  the  rubber  container  of  the  deadly  acid. 

Extreme  caution  must  !>.'  exercised  in  holding  this  acid, 
and  care  should  be  taken  to  guard  against  the  inhalation  of  its 
irritating  and  deadly  fumes.  The  deleterious  effects  from  it 
an-  very  lasting,  and  I  have  had  some  decidedly  unpleasant 
experiences  with  it,  to  which  I  would  not  care  to  have  any  of 
my  readers  subjected. 

Into  this  cup  is  poured  one  ounce  of  the  hydrofluoric  acid, 
which  can  be  procured  at  a  chemist's  shop  in  four  ounce  wax 
bottles.  The  wax  cork  is  then  sealed  into  the  bottle,  the  bottle 
placed  in  a  wooden  box,  and  put  away. 

In  the  average  practice  an  ounce  of  this  acid  will  serve  its 
purpose  for  about  three  weeks  to  a  month,  when  it  becomes  so 
laden  with  silicates  that  it  may  be  pronounced  inert  from  cleans- 
ing inlays. 

The  cup  is  then  removed  from  its  seat  in  the  plaster  base 
and  carefully  filled  with  water  which  runs  slowly  out  from  the 
faucet  and  is  allowed  to  overflow  the  cup. 


212  CAST  GOLD  AND  PORCELA1X  INLAYS 

This  so  weakens  the  acid  that  it  will  not  hurt  the  basin. 
When  the  cup  has  been  thoroughly  cleansed,  it  is  replaced  in 
its  plaster  seat,  another  ounce  of  the  acid  is  poured  into  it  from 
the  acid  bottle,  and  the  cover  is  put  on  as  quickly  as  possible. 

It  is  well  to  take  a  quart  glass  jar,  fill  it  with  water,  and 
put  into  the  water  as  much  bicarbonate  of  soda  as  the  water 
will  take  up.  As  required,  the  test  tube  may  be  filled  and  the 
washed  inlays  boiled  in  this  solution  to  completely  neutralize  the 
acid. 

SUMMARY  FOR  CHAPTER  XV 

The  Cleansing  of  the  Casting  in  Hydrofluoric  Acid  and  in  a  Sodium 
Bicarbonate  Bath 

1.  Describe  the  cleansing  of  the  casting  from  impurities  and  give  the  reason 
for  each  step. 

2.  Describe  the  making  of  a  receptacle  for  hydrofluoric  acid. 


UIAI'TKU  XVI 

UKMOVAL  OK  Til  K  KXt'ESS  OF  MKTAL,  THE  POLISH1XC, 
AND  THE  CEMKXTATIOX  OK  TIIK   I XI, AY 

The  surplus  button  is  clamped  with  a  vise,  and  with  a  fine 
saw  the  inlay  is  separated  from  the  excess  by  sawing  through 
the  sprue,  within  a  millimeter  or  two  of  the  casting.  A  garnet 
paper  disc,  of  medium  grit,  will  remove  the  rest  of  the  sprue, 
and  medium-grit  cuttle  fish  discs  rotated  toward  the  margins 
of  the  inlay  will  prepare  it  for  its  final  polish.  Unless  the  sprue 
wire  has  been  attached  to  any  part  of  the  occlusal  surface,  the 
occlusal  part  of  the  casting  is  not  to  be  touched  with  stones, 
burrs  or  discs,  and  it  is  not  to  be  touched  at  all  until  the  inlay 
has  been  tried  in  the  cavity,  and  the  relative  occlusion  of  it 
determined. 

The  cavo-surl'aces  of  the  inlay  arc  carefully  examined  with 
a  magnifying  glass,  and  a  diligent  search  is  instituted  for  any 
irregularities,  such  as  bubbles,  etc.,  which  would,  of  course,  in- 
terfere with  the  proper  seating  of  the  inlay.  If  any  are  found, 
they  may  be  removed  with  a  very  sharp  spoon-shaped  excavator, 
or  with  a  Xo.  1  or  Xo.  2  round  burr,  held  in  the  handpiece  of  the 
engine.  If  the  area  is  free  from  interference,  the  temporary 
stopping  is  removed  from  the  patient's  tooth,  the  cavity  is 
carefully  examined  to  make  certain  that  it  is  absolutely  free 
from  any  obstructions,  and  the  inlay  is  put  into  the  cavity  and 
sent  home  by  tapping  it  gently,  using  a  stock  of  hard  wood, 
driven  by  a  few  gentle  taps  from  a  leather-covered  mallet.  No 
undue  force  must  be  used;  gentleness  and  perseverance  are  the 
agents  that  will  overcome  the  obstacles  usually  encountered  at 
this  stage.  AVhen  the  inlay  has  gone  to  place,  all  margins  are 
carefully  examined,  with  the  aid  of  a  mirror  and  a  fine  explorer. 
If  found  satisfactory,  the  mirror  and  explorer  are  laid  aside, 
and  while  the  fingers  of  one  hand  hold  the  inlay  in  position, 
the  other  hand  manipulates  the  right,  left,  and  straight,  as  well 
as  round  burnishers,  always  in  the  direction  with  the  margins. 

213 


214  CAST    GOLD    AND    POKCELAIN    INLAYS 

If  the  directions  have  been  followed,  practically  no  bur- 
nishing should  be  required,  at  least  not  what  is  generally  under- 
stood as  burnishing. 

There  is  no  occasion  for  spinning  the  gold,  and  the  use  of 
the  burnishers  is  indulged  in  at  the  margins  only  to  obviate  the 
necessity  for  discs  at  these  points.  Discs  sometimes  slip  and  get 
beyond  one's  control  for  a  long  enough  time  to  mar  the  perfec- 
tion of  a  piece. 

If  the  inlay  proves  difficult  to  seat,  it  should  be  removed 
and  again  scrutinized  with  the  magnifying  glass  for  any  ir- 
regularities or  overhanging  ledges.  These  removed,  the  inlay 
is  again  seated,  and  the  process  of  gently  tapping  it  is  repeated. 
Because  these  inlays  fit  so  closely,  and  frictionally  engage  the 
different  Avails  of  the  cavity  so  thoroughly,  we  are  sometimes 
compelled  to  seat  and  reseat  them  several  times  before  cemen- 
tation. 

The  burnishers  must  not  be  allowed  to  slip  off  the  gold, 
onto^the  tooth;  the  object  is  rather  to  run  the  burnishers  ver- 
tically over  the  inlay  margins,  when  these  are  vertical,  and 
horizontally  over  them,  when  they  are  occlusal  or  cervical;  in 
other  words,  when  the  margins  run  horizontally  across  the 
tooth. 

With  the  sharp  point  of  a  pencil  a  line  is  drawn  across 
the  heaviest  part  of  the  inlay,  and  this  line  is  continued  over 
the  tooth. 

The  inlay  is  removed  from  the  mouth.  AVith  a  No.  2  round 
burr  a  recess  is  drilled  on  each  side  of  it,  as  near  the  margin 
as  the  enamel  line  will  permit,  and  with  a  burr  of  the  same 
size  a  similar  recess  is  drilled  in  the  tooth.  This  procedure 
gives  a  saucer-shaped,  or  rather  semicircular  depression,  on 
the  opposing  margin  of  the  inlay,  and  a  corresponding  depres- 
sion in  the  tooth.  The  pencil  mark  will  serve  as  a  guide  for 
vertical  direction,  while  the  cavity  margins  on  the  cavo-surfaces 
will  determine  the  direction  which  the  burr  will  take  in  the 
tooth. 

It  will  be  readily  realized  that  when  the  inlay  is  again 
placed  in  position,  the  two  depressions  or  recesses  on  the  inlay, 
will  meet  the  two  recesses  within  the  tooth,  and  an  almost  cir- 
cular resistance  pinion  will  result  upon  the  application  of  the 


POLISH  IXC    AND    rK. \1KXTATI  OX    OK    I  X  LA  V  I) 

cement.  Such  resistance  pinions  arc  exceedingly  strong  and 
very  •difficult  to  obliterate,  since  they  possess  the  maximum  bulk 
whore  tension  is  greatest. 

The  accuracy  of  the  proximate  relation  of  tlie  inlay,  must 
he  satisfactory;  there  must  be  contact  with  the  next  tooth,  if 
any  be  present,  if  the  inlay  bo  a  compound  one,  and  if  it  be 
one  for  anv  tooth  distally  to  the  first  bicuspid,  there  must  be 
collide!  line*  instead  of  contdcl  ))ohils. 

If  any  deficiency  be  observed  at  those  parts,  it  may  bo 
rectified  by  doubling  a  cylinder  of  gold  foil  upon  itself,  and 
placing  it  snugly  upon  the  deficient  part  of  the  inlay  with  the 
smallest  quantity  of  'I'l  carat  solder,  this  cylinder  is  joined  to 
the  inlay  proper,  and  the  bulk  of  it  at  that  point  is  increased. 

Tlie  necessity  for  such  steps,  as  described  immediately 
above,  will  become  rarer  as  the  technic  is  mastered. 

It  will  be  recalled  that  the  margins  of  the  inlay  were  pol- 
ished by  the  use  of  the  burnishers,  while  it  was  in  the  tooth 
cavity.  The  rest  of  it  is  now  finished  with  line  cuttle-fish  discs, 
to  be  followed  by  crocus  discs.  The  occlusal  surface  having 
been  found  correct,  it  is  polished  with  small  brush  wheels  and 
pumice,  and  finally  with  felt  wheels,  and  pointed  slender  engine 
burnishers.  If  there  has  been  a  slip-up  on  the  occlusal  surface, 
the  inlay  is  put  into  the  cavity,  carefully  seated,  and  the  patient 
is  asked  to  bring  the  teeth  into  occlusal  relation,  while  a  small 
piece  of  thin  articulating  paper  is  held  over  the  tooth  that  con- 
tains the  inlay.  In  this  manner  the  interfering  high  points  Avill 
be  readily  noticed  and  may  be  removed. 

The  necessity  for  this  procedure  also  will  grow  less  fre- 
quent, as  the  knowledge  of  both  the  process  and  the  technic 
grows  with  practice. 

AVhen  the  inlay  has  been  subjected  to  all  necessary  trials, 
when  the  recesses  have  been  made,  and  the  inlay  has  been  pol- 
ished, we  are  ready  for  cementation.  Use  the  rubber  dam 
whenever  at  all  possible.  It  is  so  much  easier  to  keep  the  field 
of  operation  dry,  and  the  cavity  thoroughly  clean;  steriliza- 
tion of  the  cavity  is  so  much  more  readily  accomplished;  and 
the  operation  is  so  much  more  of  an  assured  success,  that  all 
arguments  are  in  favor  of  the  rubber  dam. 

In  cases  in  which  it  is  impossible  to  use  the  rubber  dam 


216  CAST  GOLD  AND  POHCELA1X  INLAYS 

(a  condition  whicli  is  exceedingly  rare)  the  clamp  may  be  ad- 
justed on  the  tooth  to  be  filled,  or  the  one  immediately  behind 
or  in  front  of  it,  if  the  tooth  be  an  upper  one;  or  the  saliva 
ejector  of  Nyman  may  be  used,  if  the  tooth  be  a  lower  one. 
These  saliva  ejectors  were  designed  by  Dr.  Xyman,  of  Chicago, 
and  offer  an  excellent  means  of  keeping  the  field  of  operation 
fairly  dry  with  the  aid  of  cotton  rolls. 

Of  course,  napkins  or  cotton  rolls  may  be  used  when  the 
clamps  are  being  relied  upon  to  keep  the  operating  area  more 
or  less  isolated. 

We  will  assume  that  we  have  been  able  to  apply  the  rubber 
dam,  and  thus  are  enabled  to  successfully  isolate  the  tooth  we 
are  working  on,  as  well  as  several  adjoining  ones. 

The  cavity  is  thoroughly  dried,  as  well  as  cotton  will  dry 
it,  a  fresh  pledget  of  cotton  is  dipped  into  warm  alcohol,  and 
the  cavity  is  flushed  with  this;  the  walls,  as  well  as  the  seat,  of 
the  cavity  are  carefully  rubbed  with  this  pledget  of  alcohol- 
carrying  cotton. 

This  is  kept  up  for  a  minute,  when  a  stream  of  warm  air 
will  dry  the  tooth.  A  pledget  of  fresh  cotton  is  now  dipped 
into  a  solution  of  warmed  bichloride  in  H202  1-250,  and  this  is 
put  into  the  cavity  and  allowed  to  remain  there  from  three  to 
five  minutes  while  preparations  are  made  for  the  mixing  of  the 
cement. 

A  dry  cement  slab  is  essential.  Any  good  reliable  cement 
of  an  exceedingly  fine  grain  and  preferably  of  brown  color  will 
do.  A  broad  spatula  of  German  silver  or  agate  or  bone  should 
be  used,  and  the  cement  must  be  rather  thinly  mixed,  but  very 
thoroughly  spatulated.  Spread  the  mix  over  as  large  an  area 
as  possible;  the  more  you  can  spread  it  out,  the  thinner  the 
layer,  the  better  the  mix,  the  more  thorough  this  incorporation 
of  powder  into  liquid  has  been. 

The  inlay  has  in  the  interim  been  washed  by  the  assistant 
or  operator  himself  and  dried  with  warm  air. 

The  bichloride  is  removed  from  the  tooth  and  the  cavity 
is  dried  with  cotton  and  again  flushed  with  alcohol  and  dried 
with  warm  air. 

A  jiffy  cement  tube  is  filled  with  the  cement  and  a  thin 
layer  of  the  mix  is  spread  over  the  cavo-surface  of  the  inlay. 


POLISH  INC    AND    CKMKNTATIOX    OF    INLAY  1*17 

The  contents  of  the  jiffy  tube  arc  expelled,  directing  them  into 
the  cavity,  by  linger  pressure,  and  the  inlay  is  grasped  with  a 
pair  of  tweezers,  or  the  fingers,  and  guided  to  its  position  over 
and  into  the  cavity.  The  greatest  care  must  In-  used  in  seating 
the  inlay  at  this  time,  and  again  gentle  tapping  rather  than 
sudden  force  will  accomplish  the  desired  end. 

(irasp  a  pointed,  notched  hardwood  instrument  of  consider- 
able strength,  in  each  hand,  and  holding  both  of  these  points 
upon  the  inlay,  gently  rock  it  into  place,  while  the  surplus  ce- 
ment is  being  forced  out.  AVhen  the  inlay  is  nearly  in  place, 
the  wood  stick  from  the  right  hand  is  laid  aside,  and  the  mallet 
is  called  upon  to  further  the  work  until  the  inlay  is  seated.  The 
stick  is  then  substituted  for  the  mallet  and  the  inlay  is  held 
there  for  fifteen  or  twenty  minutes,  the  same  position  being 
maintained  as  nearly  as  possible.  Be  sure  the  inlay  is  in  its  seat 
and  do  not  rock  it  after  that. 

Xo  burnishing,  no  malleting,  no  polishing,  no  trimming 
down  of  any  kind,  for  at  least  a  day  after  cementation.  When 
the  cement  has  crystal! i/ed,  the  rubber  dam  is  removed,  the 
surplus  cement  around  the  inlay  is  removed,  and  the  patient  is 
cautioned  against  using  that  tooth  or  that  side  of  the  mouth 
for  the  next  few  hours  to  come,  in  order  to  properly  preserve 
the  continuity  of  the  cement  while  it  is  hardening. 

Upon  the  return  of  the  patient  for  the  next  sitting  the 
margins  may,  if  necessary,  be  burnished;  the  right  and  left  bur- 
nishers may  be  used  as  indicated,  or  the  small  engine  burnishers 
may  be  employed. 

If  all  directions  have  been  carefully  followed,  this  will 
rarely  if  ever  be  required,  but  should  the  necessity  arise,  it  is 
well  to  remember  that  the  burnishing  is  to  be  done  in  line  with, 
and  not  against,  the  margins  of  the  cavity. 

SUMMARY  FOR   CHAPTER  XVI 
Removal  of  the  Excess  of  Metal,  the  Polishing  and  Cementation  of  the  Inlay 

1.  Describe  tin-  preparation  of  the  inlay  before  it  is  tried  in  the  cavity. 

2.  Describe  the  test  fitting  of  the  inlay  in  the  cavity. 

3.  In  what  manner  should  the  margins  be  burnished? 

4.  Describe  the  making  of  the  resistance  pinion. 

5.  How  would  you  restore  the  contact  point  of  an  inlay f 

<i.  Describe  the  polishing  of  the  inlay  before   it  is  ready  for  cementation. 
7.  Describe  the  cementation  process. 


CHAPTER  XVII 

THE  SPLINTING  OF  LOOSE  TEETH  BY  ALLANS 
OF  INLAYS 

The  Splinting  cf  Loose  Teeth  by  Means  of  the  Cast  Gold  Inlay,  and 

the   Paralleling   cf  the  Root   Canals   of   Loose   Teeth  that   Are 

to  Be  Splinted,  by  Means  of  Instruments  Known  as  the 

Parallelometer  and  the  Parallelodrill,  Respectively 

The  splinting  of  loose  teeth  lias  always  been  a  more  or  less 
difficult  task  for  the  operator  to  perform.  Particularly  does 
this  apply  to  the  splinting  of  anterior  upper  or  lower  teeth. 

The  reason  for  this  becomes  obvious  when  we  consider  the 
position  of  the  upper  anteriors  and  their  longitudinal  relation 
to  each  other,  and  when  we  take  into  consideration  the  size  and 
formation  of  the  lower  anteriors. 

The  first  general  principle  to  be  observed  is  that  we  must 
never  remove  enough  tooth  structure  from  tho  inner  part  of  the 
tooth  to  endanger  its  possibility  of  playing  its  part  in  the  con- 
tinuous flow  of  vital  essence.  In  other  words,  we  must  never 
ream  out  or  drill  a  canal  so  that  only  a  thin  bony  shell  will 
remain  in  tha  alveolar  socket,  for  if  we  <lo,  not  only  will  the 
shell  be  likely  to  split  under  stress,  but  the  maintenance  of 
nutrition  is  a  much  more  difficult  thing  in  a  thin  layer  consist- 
ing largely  of  inorganic  material,  and  wherein  the  major  part  of 
the  channels  of  nutrition  have  been  segregated  from  each  other 
(their  anastomoses  destroyed),  than  it  would  be  in  a  thicker 
mass  in  which  the  tubules  still  communicate  with  each  other 
and  so  carry  the  vital  essence  to  every  cell. 

The  problem  of  establishing  a  parallel  relation  between  the 
canals  of  these  teeth,  without  destruction  of  too  much  of  the 
valuable  intertwining  nutriment  carrying  tubules,  led  the  writer 
to  the  invention  of  certain  instruments  which  are  respective!  y 
known  as  a  parallelometer  and  a  parallelodrill.  The  use  of 

218 


SPLlXTIXi;    LOOSK    TKKTII     WITH     INLAYS 


I'll) 


Fig.  176. — Showing  the  parallelometer  wrench  in  position  on  locking  stud. 
You  will  note  that  stud  is  the  only  one  on  the  parallelometer  which  has  no 
clamp  connected  with  it.  When  the  distance  which  the  operator  wants  to  main- 
tain lias  been  reached,  this  stud  is  turned  up  tightly  and  the  meter  is  locked 
beyond  any  possibility  of  change.  Great  care  should  be  taken  by  the  operator 
to  always  see  that  this  stud  is  loosened  before  attempting  to  turn  the  actuating 
screw  of  the  parallelometer.'  This  screw  has  JIG  threads  to  the  inch,  and  could 
very  easily  be  damaged  or  jammed,  if  the  locking  stud  were  turned  up  tightly 
and  an  attempt  made  to  turn  the  actuating  screw. 


Fig.  177. — In  order  to  make  clear  the  correct  position  for  the  various  man- 
drels for  different  distances,  the  following  cuts  are  shown  for  guidance. 

In  the  above  cut,  the  measuring  posts  are  in  position  for  all  measurements 
from  6  mm.  up  to  and  including  10  mm.  Six  millimeters  is  the  minimum  distance 
that  can  be  measured  with  this  instrument. 


220  CAST  GOLD  AXD  PORCELAIN  INLAYS 

these  instruments  is  a  simple  procedure  and  makes  the  parallel- 
ing of  any  number  of  teeth  in  the  arch  a  definite  and  mechan- 
ically accurate  task. 

Let  us  assume  that  we  are  about  to  make  a  splint  for  the 
six  anterior  upper  teeth  and  that  all  root  work  has  been  prop- 


Fig.  178. — Measuring  posts  in  same  clamps  as  in  preceding  cut,  but  with 
the  distance  between  them  increased  to  10  mm.  This  is  the  maximum  distance 
that  can  be  measured  with  the  posts  in  these  clamps. 


Fig.  179. — Showing  position  of  measuring  posts  for  all  measurements  from 
10  mm.  up  to  and  including  25  mm.  The  above  is  the  maximum  distance  that 
can  be  measured  with  the  posts  in  these  clamps. 

erly  executed,  that  the  canals  have  been  filled  for  their  gingival 
half,  and  that  no  undue  reaming  out  of  the  roots  has  been  re- 
sorted to.  We  shall  use  a  15-gauge  (Brown  &  Sharp)  30  per 


SPLINTING    LOOSE    TKKTII     WITH    INLAYS  '2'2 1 

cent  iriilio-platinum  wire  for  the  cuspids  and  centrals  and  a 
16-gauge  wire  for  the  lateral  incisor. 

Everything  being  ready  for  paralleling  the  canals  of  these 
teeth,  we  turn  our  attention  to  the  instrument  known  as  a 
parallelometer  and  note: 


Fig.  180. — Pleasuring  posts  in  same  clamps  as  in  Fig.  179,  but  with  the 
distance  increased  to  40  mm.  This  is  the  maximum  distance  that  can  be  measured 
with  the  posts  in  these  clamps. 


Fig.  181. — When  the  distance  to  be  measured  exceeds  40  mm.,  the  parallelom- 
eter is  reversed  and  the  measuring  posts  are  placed,  in  the  clamps  as  shown  above. 
These  posts,  as  can  be  seen,  are  now  35  mm.  apart.  The  parallelometer  may  bo 
extended  to  55  mm.  , 

1.  It  consists  of  two  rectangular  pieces  of  metal,  slidably 
adjustable  one  upon  the  other,  a  screw  providing  the  means 
of  motion. 


'2'2'2  CAST    GOLD    AND    POKCKLA1X     IX LAVS 

2.  At  fixed  distances  upon  the  piece  of  metal,  certain  clamps 
are  present,  which  will  upon  being  locked,  definitely  hold  a 
given  wire  in  a  fixed  groove. 

3.  The   upper  surface   of  the   engaging   sections   is   accu- 
rately graduated  in  millimeters,  a  constantly  augmenting  num- 
ber of  turns  of  the  screw  being  necessary  to  traverse  a  milli- 
meter space  as  the  first  groove  upon  the  table  section  and  the 
last  groove   upon   the   movable   section  approach   each   other. 
This  instrument  will  line  up  root  canals  parallel  to  each  other, 
when  they  are  7  or  40  mm.  apart,  and  we  must  bear  in  mind 
that : 

First.    If  we  wish  to  parallel  the  canals  of  two  teeth  which 
are  over  7  mm.  and  less  than  10  mm.  apart,  we  clamp  a  wire  of 


Fig.  182. — Measuring  posts  in  same  clamps  as  in  Fig.  181,  but  the  distance 
has  been  increased  to  55  mm.  This  is  the  maximum  range  of  the  parallelometcr 
and  will  reach  from  any  part  of  the  mouth  to  any  other  part  of  the  mouth. 


suitable  gauge  into  the  two  opposite  grooves  farthest  away  from 
the  actuating  screw. 

Second.  When  the  canals  to  be  paralleled  are  more  than 
10  and  less  than  25  mm.  apart,  we  use  the  end  groove  of  the 
stable  section  as  our  unit  point,  and  the  middle  grove  of  the 
movable  section  as  our  point  of  accommodation  or  adjustment. 

Third.  When  the  canals  to  be  paralleled  are  more  than  25 
or  less  than  40  mm.  apart,  we  use  the  end  groove  of  our  stable 
section  as  our  unit  point,  and  that  groove  upon  the  movable 
section  which  is  nearest  the  actuating  screw  as  our  point  of  ac- 
commodation or  adjustment. 

Given  a  case  which  requires  splinting  of  the  six  anterior 
teeth,  we  would  then  proceed  as  follows : 


Sl'UNTINi;     I.OOSK    TKKTII     WITH     IX  LAVS 


1.  The  teeth  must  be  thoroughly  scaled  and  polished. 

2.  All  suppurative  conditions  must  be  eliminated. 

o.  All  the  pul])s  must  be  extirpated  and  the  roots  filled  for 
their  gingival  half  in  accordance  with  the  best  technic. 

4.  The  incisal  orifices  of  the  pulp  chambers  are  enlarged 
by  means  of  stones  suitable  in  shape  and  size. 

5.  Starting  with  the  two  cuspids,  they  will  be  found  to  be 
more  than  '2')  nun.  and   less  than  40  mm.  apart,  and  we  shall 
therefore  clamp  two  hVgauge  (Brown  &  Sharp)  steel  rods  into 


Fig.  IS.'!. — The  above  cut  shows  where  the  paiallelodrill  should  be  oiled.  A 
drop  of  oil  should  be  placed  in  C  and  D  occasionally;  the  cap  at  B  should  be  re- 
moved, and  the  pinion  underneath  it  oiled;  also,  the  caps  at  A  and  A.  The  latter 
caps  have  a  left-hand  thread. 

The  parallelodi  ill  cannot  be  steiili/.ed  by  boiling,  due  to  the  fact  that  certain 
pinions  and  parts  are  made  of  steel,  the  drill,  however,  may  be  entirely  dissembled 
and  easily  reassembled,  and  all  parts  wiped  off  carefully. 

A  ci-nterin^  post  is  provided  in  the  set  of  instruments  to  assist  assembling  the 
parallelodrill  when  it  lias  b:-en  taken  apart  to  be  cleaned.  This  centering  post  is  the 
same  size  as  the  c, 'liter  stud  which  holds  the  two  drill  heads,  pinions,  etc.,  together. 
Instead  of  aligning  the  abo\v  parts  with  the  center  stud,  the  centering  post  should 
be  used,  and  in  that  way,  no  harm  will  be  done  to  the  thread  of  the  stud. 


224 


CAST  GOLD  AND  PORCELAIN  INLAYS 


the  corresponding  grooves  presenting  themselves  upon  the  op- 
posite sides  of  the  parallelometer. 


Fig.   184. — Distance  established  between  cuspids.     The  drills  are   too  be  the  same 

distance  apart. 


Fig.  185. — Showing  the  operation  of  the  parallelodrill  reaming  out  two  root 
canals  in  the  two  upper  cuspids  to  receive  the  split  pin  and  tube  attachments.  Note 
the  position  of  the  operator's  left  hand  in  supporting  the  parallelodrill  during  this 
operation. 

\ 

6.  We  join  the  actuating  screw  until  the  two  posts  or  wires 
will  just  enter  the  root  canals  of  the  two  cuspid  teeth. 

7.  Eemoving  the  instrument  from  the  mouth,  we  fix  the 


SPLINTING    LOOSE    TEETH    WITH    INLAYS  223 

distance  between  the  two  posts  by  means  of  the  lock  nut  pro- 
vided and  we  record  this  distance  for  future  reference. 

8.  AVe  remove  the  two  wires  from  their  respective  grooves 
by  opening  the  clamps  and  we  substitute  two  short  posts  which 
we  accurately  clamp  into  the  meter,  and  which  will  engage  the 
two  heads  of  the  parallelodrill. 

9.  The  drill  heads  of  the  parallelodrill  are  now  made  to 
engage  the  protruding  ends  of  the  short  posts,  and  the  distance 
between  the  drill  heads  is  fixed  by  turning  the  lock  nut  pro- 
vided. 

10.  The  parallelodrill  is  removed  from  the  posts,  clamped 
into  the  parallelometer  and  two  drills,  corresponding  in  size  to 
the  original  wires,  are  now  inserted  into  the  drill  heads. 

1 1 .  The  parallelodrill  is  mounted  onto  the  handpiece  of  the 
engine  and  the  drill  heads  carrying  the  two  drills  are  brought 
into  line  with  the  canals  of  the  two  cuspids. 

12.  The  power  is  turned  on  and  the  drills  are  allowed  to 
sink  into  the  two  root  canals  to  the  required  depth. 

1:>.  This  varies  directly  as  the  amount  of  destruction  of 
the  alveolus  and  the  recession  of  the  gum  and  inversely  as  the 
divergence  of  the  roots. 

14.  The  drills  must  be  sharp,  allow  for  clearance,  the  hand 
must  be  steady  and  the  mind  must  be  fixed  upon  the  task  in  hand. 

15.  It  will  be  found  that  the  canals  in  the  cuspids  will  be 
parallel  without  difficulty  and  with  the  least  sacrifice  of  tooth 
structure. 

We  shall  now  proceed  to  parallel  the  right  cuspid  to  the  left 
lateral  or  rather  the  left  lateral  to  the  right  cuspid. 

Taking  up  the  instrument  called  the  parallelometer  we  re- 
lease the  lock  nut  which  will  enable  the  actuating  screw  to  func- 
tion, then  proceed  as  follows: 

1.  The  clamp  which  holds  the  wire  upon  the  accommodating 
section  in  the  groove  nearest  the  actuating  screw  is  opened  and 
the  wire  is  removed. 

2.  The  space  between  the  right  central  and  the  left  lateral 
becomes  more  than  10  mm.  and  less  than  25  mm.  apart.    This 
wire  is  clamped  into  the  middle  grove  of  the  movable  or  ac- 
commodating section. 

3.  The  actuating  screw  is  turned  until  the  two  wires  will 


226 


CAST    GOLD    AND    POIK'HLAIN    INLAYS 


be  in  line  with  the  incisal  orifices  of  the  canals  of  the  right  cen- 
tral and  left  lateral  respectively,  and  will  just  enter  these  canals. 

4.  The  parallelometer  is  removed  from  the  mouth  and  the 
distance  between  the  two  wires  is  noted,  recorded,  and  fixed  by 
turning  the  lock  nut  provided. 

5.  The  clamps  holding  the  wires  are  opened,  the  latter  are 
removed  and  the  short  drill  guides  or  alignment  posts  are  placed 
into  the  grooves  and  the  clamps  are  locked. 


Fig.   186-J. 


Fig.   186-5. 

Fig.   186. — Showing  the  method  of  transferring  the  distance   from  the  paral 
lelometer  to  the  parallelodrill. 

1.  Measuring  posts  in  position  after  having  the  distance  increased  between  them 
by  2y%  mm. 

2.  Alignment  posts  have  been   substituted   for  measuring  posts  and  tightened 
up  in  their  respective  clamps. 

3.  Parallelodrill  has  been  unlocked  and  the  two  drillheads  superimposed  on  the 
pyramidal-shaped  alignment  posts.     The  handle  of  the  drill  has  been  turned  to  the 
most  convenient  angle  for  the  work  to  be  done  in  the  mouth,  and  the  two  drillheads 
locked  in  that  position. 

4.  The  parallelodrill  removed  from  alignment  posts  with  the  distance  accurately 
transferred  from  the  parallelometer  to  the  parallelodrilL 


SPUXTIXd    I.OOSK    TKKTII     WITH     IXI.AYS  '' 

6.  The  parallelodrill  is  deprived  of  its  drills,  the  lock  nut 
upon  its  center  is  opened,  and  the  two  drill  heads  are  made  to 
engage  the  extending  ends  of  the  drill  guides  or  alignment  posts 
which  are  clamped  in  the  meter. 

7.  The  distance  between  the  drill  heads  is  fixed  by  turning 
the  lock  nut  provided,  and  the  drill  head  which  is  to  be  oposite 
the  lateral  incisor  is  provided  with  a  drill  of  suitable  size  and 
make,  while  the  one  which  is  to  coact  with  the  cuspid  is  made 
to  carry  a  smooth  wire  of  the  same  caliber  as  the  drill  previously 
used  in  paralleling  the  cuspids. 

8.  The  parallelodrill  is  slipped  into  the  handpiece  of  the 
engine,  and  the  drill  and  the  guide  wire  are  brought  into  line 
with  the  respective  canals. 

!'.  The  power  is  turned  on  and  the  drill  is  .allowed  to  find 
its  way  into  the  canal  of  the  lateral,  the  guide  wire  in  the  Other 
drill  head  entering  the  canal  of  the  cuspid,  will  provide  the 
means  of  compelling  alignment  of  left  lateral  to  right  cuspid. 

10.  The  right  cuspid  canal  having  been  made  parallel  to 
the  left  cuspid  canal,  at  the  initial  alignment  operation,  the  left 
lateral  will  of  course  be  found  parallel  to  the  left  cuspid. 

11.  If  we  now  reverse  the  process,  that  is,  if  we  now  turn 
our  attention  to  the  left  cuspid  and  right  lateral,  employ  the 
same  technic  outlined  above,  merely  transferring  our  drilling 
member  to  the  oposite  drill  head,  we  may  readily  bring  into 
parallel  alignment  the  right  lateral  with  the  left  cuspid,  and 
hence  also  with  the  right  cuspid,  and  hence  also  with  the  left 
lateral. 

1±  Tn  like  manner,  the  canals  of  the  right  and  left  central 
may  be  made  parallel  to  the  left  and  right  cuspids,  respectively, 
and  you  who  have  been  working  in  the  dark,  guessing  at  the 
parallelism  of  your  splint  posts  have  a  revelation  awaiting  you, 
when  you  follow  the  technic  outlined  above. 

Exactly  the  same  technic  would  have  to  be  followed,  if  the 
lower  anteriors  were  the  ones  to  be  worked  upon,  except  that  the 
wires  and  drills  to  be  used  would  have  to  be  smaller. 

The  average  size  posts  for  the  four  lower  incisors  is  17- 
gauge  (Brown  tv.  Sharp),  while  the  cuspids  will  take  a  15-gauge 
wire  of  the  same  standard. 

If  now  the  six  anteriors,  upper  or  lower  teeth  were  to  be 


228 


CAST  GOLD  AND  PORCELAIN  INLAYS 


splinted,  by  means  of  cast  gold  inlays,  and  the  two  cuspids 
were  to  be  used  as  abutments  for  a  bridge,  as  frequently  they 
must  be,  the  procedure  would  be  to  substitute  tubes  for  the 
post,  which  were  to  be  inserted  into  the  root  canals  of  the  cus- 
pids. 

The  technic  for  paralleling  would  be  the  same  as  previously 


Fig.  187. — Distance  established  between  cuspid  and  lateral  on  opposite  side 

of  the  arch. 


Fig.  188. — Distance  established  between  right  cuspid  and  left  lateral. 
Drills  are  the  same  distance  apart. 

outlined,  except  that  the  posts  used  in  alignment  of  the  upper 
cuspids  would  be  13-gauge  (Brown  &  Sharp),  while  the  drills 
which  are  to  sink  the  shafts  are  a  No.  12  (Brown  &  Sharp),  and 
for  the  lower  cuspids  14-gauge  wire  (Brown  &  Sharp)  would  be 
used  to  be  followed  with  a  13-gauge  drill. 

When  the  canals  in  the  cuspids  have  been  paralleled,  the 


.SPLINTING    LOOSE    TEETH    WITH    INLAYS 

cavities  are  cut  into  the  teeth,  linguo-distally,  occupying  a 
goodly  portion  of  the  lingual  surface  and  extended  mesially  so 
as  to  almost  reach  the  labial  surface. 

The  parallelometer  carrying  two  wire  posts  13-gauge 
(Brown  &  Sharp)  clamped  in  their  respective  grooves  is  now 
lifted  into  the  parallel  canals.  The  instrument  is  removed  from 
the  mouth,  and  the  distance  between  the  posts  is  noted,  recorded, 
and  fixed  by  turning  the  lock  nut. 

Two  friction  angle  trays,  properly  lubricated,  are  now 
mounted  upon  posts  and  two  platinum  tubes  are  slipped  over 
and  onto  the  posts,  the  wall  of  these  tubes  is  .007  mm.  thick. 
The  trays  are  moved  up  the  wires  until  the  incisal  end  of  the 
tubes  will  disappear  into  the  sleeves  of  the  trays. 

Inlay  wax  is  now  melted  upon  the  tray  and  around  the  tube, 
the  outer  wall  of  which  has  been  knurled  by  rolling  it  under  a 
fine  file.  The  wax  is  built  up  into  the  shape  of  a  small  pyramid 
upon  both  trays,  and  the  instrument  now  carrying  trays,  wax 
and  tubes,  is  guided  back  into  the  root  canal  of  the  cuspid  teeth, 
and  forced  into  position.  The  trays  carrying  the  wax  are  now 
brought  up  so  that  the  wax  will  be  forced  into  the  cavity.  A 
stream  of  cold  air  is  directed  upon  the  cuspids,  while  the  trays 
are  held  in  this  position,  until  the  wax  has  stiffened  beyond  the 
possibility  of  change  and  form. 

The  instrument  is  now  removed  from  the  mouth,  and  with 
a  small,  sharp  lancet,  the  surplus  of  wax  is  cut  or  carved  away. 
The  clamps  which  hold  the  wires  in  the  respective  grooves  upon 
the  meter  arc  opened,  and  the  wires,  which  carry  tray,  wax 
and  tubes  are  released.  A  pin  vise,  held  in  the  right  hand, 
grasps  tin-  tube,  while  the  left  hand  carefully  moves  the  tray 
downward  upon  the  wire,  and  finally  the  tube  and  wax  inlay 
as  one  are  removed  from  the  wire.  With  a  lancet  and  proper 
carvers,  the  lingual  portion  of  the  wax  inlay  is  now  carved  out 
into  a  retentively  formed  cavity,  to  be  subsequently  occupied 
by  an  inlay,  which  carrying  a  split  pin,  will  engage  the  platinum 
tube,  and  which  inlay  and  split  pin,  in  conjunction  with  the  one 
upon  the  opposite  side,  will  be  joined  to  the  bridge  to  serve  as 
attachments  for  it. 

A  graphite  post  from  which  the  oil  has  been  thoroughly 
burned  out,  and  which  is  of  the  same  caliber  as  the  wire,  which 


230 


CAST  (JOLI)  AND  PORCKLAI X  INLAYS 


fitted  into  the  platinum  tube,  is  now  inserted  into  the  tube,  a 
sprue  wire  is  heated  and  inserted  into  that  portion  of  the  wax 
inlay  which  is  thickest,  and  farthest  away  from  the  platinum 
tube.  The  sprue  wire  is  inserted  in  such  an  angle  that  the  mol- 
ten gold,  upon  being  forced  into  the  mold,  will  not  strike  the 
tube  as  an  obstruction,  in  its  travel,  but  will  raher  have  a 
chance  to  attacli  itself  to  it  in  an  enveloping  maner. 


Fig.  189. — Distance  established  between  left  cuspid  and  right  central. 
Drills  are  the  same   distance  apart. 


Fig.  190.- — Distance  established  between  right  cuspid  and  left  central. 
Drills  are  the  same   distance  apart. 

The  cavities  in  all  the  anterior  teeth,  which  are  to  be 
splinted  together,  must  be  extended  mesio-distally  in  such  a 
manner  that  the  inlays  that  are  to  be  made  for  these  cavities 
may  be  joined  to  one  another  with  a  sufficient  quantity  of  solder 
to  provide  the  necessary  strength,  and  yet,  without  that  solder 
coming  up  to  any  of  the  margins,  so  that  there  may  be  no  dif- 


Sl'LIXTIXC    LOOSE    TKF.TII     WITH     INLAYS 


231 


ficulty  about  the  proper  care  in  keeping  these  margins,  between, 
inlay  and  cavity,  perfectly  clean. 

These  inlays  for  the  lingual  surfaces  of  the  teeth  which  are 
to  he  splinted  are  most  easily  made  in  the  following  manner: 

A  threaded  post  of  the  proper  diameter  is  made  to  pierce 
a  cone  of  inlay  wax;  a  piece  of  German  silver  plate  about  30- 
gauge,  and  somewhat  larger  in  area  than  the  lingual  surface 
of  the  tooth,  is  perforated  and  slipped  onto  the  wire  post,  so 
as  to  act  as  a  tray  for  the  wax.  The  wire,  wax  and  tray  are 
now  inserted  into  water  138°  F.  for  about  two  minutes,  and  the 
wire,  grasped  with  the  thumb  and  index  finger,  the  top  of  the 
lingers  making  a  rest  for  the  German  silver  tray,  that  portion 
of  the  wire,  which  penetrates  and  extends  beyond  a  cone  of  in- 
lay wax,  is  now  placed  into  the  root  canal  of  the  tooth,  allowed 
to  occupy  all  the  depth  provided  for  it,  and  the  German  silver 
tray  is  brought  up  against  the  wax,  thus  forcing  the  same  into 
every  portion  of  the  cavity  not  occupied  by  the  wire.  With 
the  tray  under  pressure,  a  stream  of  cold  water  is  directed  upon 
the  tooth,  until  the  wax  cones  become  fixed  in  that  position, 
when  the  wire  and  the  wax  inlay  and  the  tray  may  be  removed. 

With  a  sharp  lancet  all  the  surplus  wax  is  carefully  trimmed 
away,  the  German  silver  tray  is  removed  from  the  wire,  and 
the  wax  inlay  and  post  are  now  replaced  into  the  cavity,  and 
with  the  proper  carvers,  and  flat  right  and  left  burnishers,  the 
wax  is  made  to  acquire  its  proper  disto-linguo-mesial  outline. 
The  post  and  inlay  are  now  carefully  removed  from  the  tooth, 
and  the  sprue  wire  is  inserted  as  previously  indicated  in  such 
a  manner  that  when  the  mold  is  ready  to  receive  the  molten 
metal,  the  post  shall  not  act  as  an  obstruction  to  its  (metal) 
free  ingress  into  the  cavity. 

In  this  manner,  all  the  post-carrying  inlays  for  the  teeth 
involved  are  completed  and  placed  into  their  respective  cavities. 
If  the  teeth  are  very  loose  they  must  be  supported  in  proper 
position  before  any  attempt  is  made  to  take  an  impression  of 
the  inlays  as  assembled.  This  is  best  accomplished  in  the  fol- 
lowing manner: 

With  a  silk  ligature  the  teeth  are  drawn  into  proper  rela- 
tion to  each  other  and  firmly  tied,  the  ligature  must  be  placed 
as  near  to  the  incisal  edge  as  possible,  without  exposing  it  to  the 


232 


CAST  GOLD  AND  PORCELAIN  INLAYS 


likelihood  of  its  slipping,  a  stick  of  De  Tray's  modeling  com- 
pound may  be  softened  and  placed  upon  the  labial  surface  of 
the  teeth,  extending  from  the  gingiva  up  to  the  incisal  third, 
and  reaching  around  to  one-half  of  the  distal  surfaces  of  the 
cuspids,  held  in  this  position,  the  modeling  compound  is  chilled 
with  a  stream  of  cold  water.  A  plaster  impression  may  now  be 
taken  with  the  inlays  and  modeling  compound  in  position,  and 
when  the  plaster  begins  to  set,  a  stream  of  cold  air  should  bo 


Fig.  191. — Finished  splint  ready  to  be  inserted.     Note  the  perfect  alignment  of  the 
posts.     (Sketch  made  by  Dr.  Leo  Stern.) 


directed  upon  the  tray  in  order  to  prevent  the  heat,  generated 
by  the  crystallization  of  the  plaster,  from  softening  the  com- 
pound or  a  1)1  ast  of  cold  air  may  be  played  upon  the  tray. 

When  the  plaster  has  hardened,  the  tray  is  removed,  the 
labial  portion  of  the  impression  is  lifted  off,  and  usually  the 
improvised  modeling  composition  splint  will  come  with  it.  The 
ligature  is  then  removed  from  the  tooth,  and  as  a  rule  this  will 
cause  a  loosening  of  the  lingual  portion  of  the  impression,  which 


SIM.IXTIXU    LOOSK    TKETH     WITH     IXI.AVS  233 

may  now  be  removed.  If  the  inlays  liavc  remained  in  the  teeth, 
each  one  is  removed  and  placed  into  its  corresponding  seat  in 
the  impression. 

AVhen  all  of  the  inlays  have  hern  assembled  in  the  impres- 
sion, they  are  waxed  into  position,  care  being  taken  not  to  let 
the  wax  run  onto  any  of  the  margins,  their  final  security  in  posi- 
tion being  attained  by  waxing  a  piece  of  wooden  toothpick  onto 
lioth  impression  and  post  for  each  inlay,  so  that,  if  we  have  six 
inlays  in  position  in  the  impression,  we  shall  have  six  posts 
rising  in  parallel  relation  to  each  other  and  onto  each  of  these 
posts  shall  be  waxed  a  piece  of  wooden  toothpick,  the  other  end 
of  which,  shall  be  waxed  onto  the  impression.  With  a  camel's 
liair  brush,  the  cavo-surfaces  of  all  the  inlays  are  covered  with 
graphite  paste,  the  refractory  compound  is  mixed  to  its  proper 
consistency  (that  of  a  fairly  thick  paste)  and  with  this  paste 
the  impression  is  filled,  care  being  taken  to  apply  a  little  of 
the  paste  at  a  time,  using  a  brush  or  a  small  spatula  to  build  the 
refractory  compound  into  every  portion  of  the  impression,  and 
around  all  parts  of  the  inlays  and  posts,  until  a  model  of  suffi- 
cient size  has  been  secured. 

The  refractory  compound  is  allowed  to  harden  sufficiently 
to  prevent  displacement  of  any  of  the  parts  during  manipula- 
tion, coincident  with  the  separation  or  cutting  away  of  the  im- 
pression. This  cutting  away  process  must  be  carefully  done. 
\Ve  must  bear  in  mind,  that  all  our  efforts  are  directed  to  leave 
the  inlays  in  the  same  relative  position  upon  the  refractory 
model,  which  they  occupy  in  the  mouth. 

AVhen  the  impression  has  been  entirely  removed  from  the 
model,  the  inlays  situated  in  the  model  are  carefully  and  thor- 
oughly cleansed,  an  examination  is  made  to  determine  if  they 
are  in  contact  at  the  points  where  they  are  to  be  joined  to  one 
another,  and  if  they  are  not,  they  are  brought  into  contact  by 
carefully  fitting  small  pieces  of  clasp  metal,  or  iridio-platinum 
into  these  places;  the  line  of  junction  is  carefully  waxed  up, 
while  additional  refractory  compound  is  placed  upon  all  the 
exposed  parts  of  the  inlays.  After  this  has  hardened,  the  piece 
may  be  placed  upon  the  fire  for  a  few  moments,  when  the  wax- 
may  be  removed,  the  piece  may  be  replaced  on  the  flame,  allowed 
to  heat  up  for  another  few  minutes,  when  it  is  fluxed,  and  small 


234  CAST  GOLD  AXD  POKCELAIX  INLAYS 

pieces  of  solder  placed  at  the  points  where  union  is  desired. 
When  the  piece  has  been  thoroughly  heated  by  the  flame  the 
blowpipe  is  applied  and  the  inlays  are  soldered  together. 

It  is  advisable  to  allow  the  piece  to  become  fairly  cool  be- 
fore any  attempt  is  made  to  take  it  out  of  the  model.  When  the 
proper  time  comes,  this  may  be  done  and  the  now  joined  inlays 
are  removed  from  their  place  upon  the  model,  thoroughly 
scrubbed  with  soap  and  water  and  thrown  into  hydrofluoric  acid 
to  remain  for  a  period  of  half  an  hour  or  so.  They  are  removed 
from  the  hydrofluoric  acid,  thoroughly  washed,  and  thrown  into 
a  bath  of  warm  hydrochloric  acid,  again  removed,  thoroughly 
washed,  and  boiled  in  a  sodium  bicarbonate  solution.  With  lit- 
tle stones  held  in  the  engine  handpiece,  all  excess  is  now  ground 
away.  Care  must  be  taken  not  to  encroach  upon  any  margins 
during  our  finishing  and  polishing  operation. 

If  our  patient  is  waiting  for  us  to  complete  the  entire  opera- 
tion outlined  above,  no  particular  provision  for  the  care  of  the 
teeth  that  are  to  be  splinted  need  be  made  except  the  closing 
of  the  various  cavities  by  means  of  temporary  stopping.  But 
if  the  patient  is  to  be  discharged  and  is  to  be  absent  for  several 
days,  pending  the  completion  of  the  splint,  some  provision  must 
be  made  to  protect  and  support  these  loose  teeth  during  that 
time. 

I  have  found  a  most  efficient  method  of  supporting  these 
teeth  in  the  following  manner: 

The  teeth  containing  the  cavities  are  thoroughly  sprayed 
with  warm  water.  Cotton  rolls  are  applied  and  the  teeth  are 
dried  with  warm  air. 

The  saliva  ejector  is  put  into  the  patient's  mouth.  Small 
pieces  of  temporary  stopping  are  softened  and  formed  into 
cones.  The  cavities  in  the  teeth  are  lubricated  with  eucalyptol 
compound  and  a  piece  of  the  soft  cone-shaped  stopping  is  put 
into  each  tooth. 

Staples  of  round  German  silver  wire  of  suitable  thickness, 
18-  and  20-gauge,  respectively,  are  now  held  in  the  flame  and 
when  sufficiently  heated  are  allowed  to  embed  themselves  into 
first  the  left  cuspid  and  lateral,  then  the  left  lateral  and  left 
central,  then  the  left  central  and  the  right  central,  then  the 
right  central  and  right  lateral  and  finally  the  right  lateral  and 


SPLINTING    LOOSE    TEETH    WITH    INLAYS  '2',}') 

right  cuspid.  It  will  be  noticed  that  all  but  the  two  cuspid 
teeth  carry  a  double  staple.  With  a  heated  ball  burnisher  of 
suitable  size  the  staples  are  urged  deeply  into  the  temporary 
stopping  and  as  a  final  covering  one  piece  of  stopping  of  suffi- 
cient length  is  softened,  curved,  and  packed  into  the  cavities 
against  the  staples  contained  in  them.  With  proper  plastic  in- 
struments the  improvised  splint  is  finished  and  finally  made 
smooth  with  a  bit  of  cotton  dipped  into  eucalyptol  compound, 
and  the  patient  is  dismissed. 


CHAPTER  XVIII 

EXTENSIVE  RESTORATIONS  OF  OCCLUSAL 
BALANCE  BY  MEANS  OF  GOLD  INLAYS 

Patients  have  come  into  my  care,  the  occlusal  and  proximal 
surfaces  of  whose  teeth  have  been  badly  mutilated,  sometimes 
because  of  very  extensive  and  very  poorly  executed  amalgam 
fillings,  and  often  because  of  marked  attrition. 

Where  the  destruction  is  obviously  a  result  of  poor  dental 
work,  the  procedure,  though  tedious  enough,  is  comparatively 
simple. 

Study  models  are  obtained  and  record  models  may  be  made 
from  these  as  described,  or  separate  impressions  may  be  taken 
for  the  purpose  of  making  record  models. 

These  impressions  should  be  taken  in  plaster  of  Paris,  and 
should  be  removed  from  the  mouth  with  great  care,  because  of 
the  necessity  of  having  an  exact  reproduction  of  conditions  as 
they  exist  in  the  mouth. 

The  teeth  requiring  restoration  are  marked  off  on  a  chart, 
and  these  marks  are  duplicated  upon  the  study  models. 

The  patient  is  carefully  examined  as  to  age,  as  to  any 
peculiarity  or  abnormality  which  may  exist  in  the  mouth,  the 
condition  of  the  gingivfe  is  carefully  noted.  The  necks  of  the 
teeth  are  examined  with  minute  care,  and  the  occlusion  is  noted 
as  normal  or  malocclusion. 

The  information  is  elicited  from  the  patient  as  to  which 
side  is  usually  used  for  mastication;  what  food  is  usually  pre- 
ferred, and  how  much  time  is  given  to  meals. 

The  mouth  is  carefully  examined  in  the  periapical  region, 
and  all  information  obtained  is  recorded  for  reference. 

The  patient  may  be  dismissed  and  the  study  of  the  models 
begun. 

Each  model  is  carefully  examined  by  itself,  and  each  tooth 
upon  the  model,  previously  marked  as  requiring  attention,  is 

236 


EXTENSIVE    JtKSTOItATIOXS    OF    OCCU'SAL    I5ALANCK  237 

again  examined.  The  cavities  may  be  outlined  as  suggested 
heretofore,  or  the  parts  requiring  attention  may  be  painted  in 
black. 

When  the  examination  of  both  models  is  completed,  they 
are  brought  into  occlusal  relation  with  each  other,  and  the  ex- 
tent of  the  parts  lacking  upon  their  occlusal  surfaces  must  be 
carefully  noted. 

The  least  mutilated  of  the  posterior  teeth  is  now  looked 
for,  and  when  found  it  is  marked  with  the  letter  P,  indicating 
that  of  all  the  posterior  teeth  upon  these  models,  it  is  the  most 
nearly  perfect. 

The  man  who  has  diligently  memorized  the  directions  of 
stress  upon  or  against  the  different  teeth  will  not  need  to  make 


Fig.  192. — A  case  of  extensive  restoration.  Occluded  study  models  of  the  case. 
Note  the  enormous  amount  of  attrition,  the  lack  of  space  between  lower  teeth  and 
upper  ridge,  the  involvement  of  all  the  gingivse. 

the  step  now  described,  although  I  consider  it  an  advantage  to 
do  so  in  every  case. 

Each  model  is  placed  upon  a  heavy  sheet  of  drawing  paper, 
and  its  outline  is  traced  upon  the  sheet  in  pen  and  ink  or  in- 
delible pencil. 

The  location  of  each  tooth  is  now  designated  upon  the  sheet 
by  drawing  a  mesial  line  downward  between  the  centrals,  until 
the  pen  or  pencil  strikes  the  paper  and  records  the  mesial  line 
of  the  outline  of  the  model. 

Next,  a  line  is  drawn  between  the  central  and  lateral,  on 
either  side  of  the  model  down  and  onto  the  paper,  then  lateral 


238  CAST    GOLD    AND    PORCELAIN    INLAYS 

and  cuspid,  etc.,  until  the  location  or  rather,  mesio-distal  ex- 
tent of  each  tooth,  lias  been  recorded. 

With  a  pair  of  compasses,  the  thickest  portion  of  the  model 
is  measured,  a  record  is  made,  and  then  the  width  from  the 
buccal  surface  of  the  last  tooth  on  one  side,  to  the  buccal.  sur- 
face of  the  last  tooth  on  the  opposite  side  is  noted. 

The  width  from  tooth  to  tooth  is  now  substraeted  from  the 
previously  obtained  figure,  and  half  of  the  remainder  is  marked 
off  the  outline  of  the  model  on  each  side. 

Example:     Outline  at  widest  point,  50  mm. 

Width  from  buccal  surface  of  last  E.M.  to  last  L.M.,  40  mm. 

Difference  between  width  from  tooth  to  tooth  and  width  of  model,  10  mm. 
which  would  mean  the  marking  off  .of  5  mm.  on  the  inside  of  each  margin  of  the 
outline  of  the  model. 

The  measurement  from  the  distal  surface  of  the  right  cus- 
pid, to  the  distal  surface  of  the  left  cuspid,  taken  from  the 
model,  is  compared  to  the  model  at  that  point;  the  subtraction 
is  made,  the  result  divided  in  half,  and  the  sum  of  each  half  is 
marked  off  upon  the  outline  on  the  paper. 

A  perpendicular  is  now  dropped  from  the  point  recording 
the  median  line  of  the  model  to  a  line  connecting  the  two  points, 
marking  the  width  from  right  molar  to  left  molar.  (See  Figs. 
136  and  137.) 

A  line  on  each  side  is  drawn  from  cuspid  to  molar,  and  a 
line  from  cuspid  to  median  point;  this  will  result  in  a  diagram 
equal  in  extent  to  the  outside  measurement  of  the  teeth. 

The  width  of  molars  and  bicuspids,  bucco-lingually,  and 
cuspids,  labio-lingually,  is  now  taken  with  a  compass,  and 
marked  off  on  the  paper.  From  the  points  upon  the  paper, 
which  have  marked  the  mesio-distal  extent  of  each  tooth,  lines 
are  drawn  through  the  diagram  showing  the  location  of  the 
teeth.  This  will  result  in  a  series  of  quadrangular  figures,  rep- 
resenting the  teeth  in  the  model.  This  procedure  holds  for 
both  upper  and  lower  models. 

With  the  aid  of  the  chart  giving  the  direction  of  stress, 
these  directions  are  located  upon  the  sheet,  and  little  arrows 
are  placed  to  indicate  the  directions. 

Where  the  stress  is  marked,  the  arrows  are  doubled;  that 
is,  there  are  two  heads  to  the  arrow;  the  direction  in  which  the 


EXTENSIVE    RESTORATIONS    OF    OCrU'SAL    15ALAXCE 

stress  is  weaker  is  indicated  by  a  single  headed  arrow,  and  the 
weakest  point  of  stress  is  indicated  by  an  arrow  showing  only 
one  line  at  the  head.  .Marked  infra  stress  is  best  indicated  by 
a  black  mark  in  the  center  of  the  figure  denoting  the  par- 
ticular tooth.  And  the  quadrangular  figure,  corresponding  to 
the  most  nearly  perfect  posterior  tooth,  is  marked  with  a  P 
to  indicate  its  location. 

\Ye  shall,  upon* completion  of  these  -diagrams,  and  with  a 
history  of  the  case  before  us,  be  in  a  position  to  intelligently 
take  up  the  work  of  restoration. 

If  the  nearly  perfect  tooth  is  an  upper  one,  then  restora- 
tion should  begin  with  the  lower  tooth,  occluding  with  the  nearly 
perfect  upper  one,  and  if  the  nearly  perfect  tooth  be  a  lower  one, 
then  the  process  is  reversed  and  the  upper  teeth  occluding  with 
it  are  restored  first. 

Each  one  of  the  teeth  in  the  human  mouth,  except  the 
two  upper  third  molars,  and  the  two  lower  central  incisors, 
enter  into  occlusal  relations  with  two  opposing  teeth,  and 
broadly  speaking,  three  teeth,  two  uppers  and  one  lower,  may 
be  considered  as  an  illustration  of  a  lever,  one  upper  tooth 
representing  the  power  arm,  one  the  weight,  and  the  lower  tooth 
the  fulcrum.  As  a  matter  of  illustration,  the  reverse  of  this 
proposition  holds  good;  that  is,  two  lower  teeth  form,  respec- 
tively, the  power  and  weight  arm,  and  the  upper  tooth  the  ful- 
crum. AY  hen  all  parts  entering  this  relation  in  trinity,  are 
functioning  physiologically,  we  may  consider  occlusal  balance 
as  present. 

When  the  teeth  which  enter  into  occlusal  relation  with  the 
nearly  perfect  one  have  been  restored,  we  shall  have  an  occlusal 
guide  to  assist  us  in  bringing  about  occlusal  balance  in  the  en- 
tire mouth.  It  will  be  best  to  cut  the  cavities  in  the  teeth  upon 
the  models  with  small  chisels,  such  as  are  used  by  sculptors  or 
engravers.  AVe  shall  try  as  nearly  as  possible  to  duplicate  the 
ideal  line  and  margins  and  planes  upon  the  natural  teeth,  as  we 
have  cut  them  into  the  plaster. 

This  is  not  nearly  so  hard  as  it  would  seem;  in  fact,  it 
will  prove  much  easier  than  most  students  would  be  ready  to 
believe.  The  reason  too,  is  quite  simple  and  here  explained: 
If  we  had  omitted  taking  impressions  for  study  models,  and 


240  CAST  GOLD  AXD  PORCELAIN  IXLAYS 

making  our  diagram  of  stress,  and  omitted  the  outlining  of  the 
cavities  upon  the  models,  and  of  cutting  these  cavities  into  the 
models;  if  we  had  omitted  noting  the  most  nearly  perfect  tooth, 
and  had  attacked  the  case  in  hand  without  study,  haphazardly, 
it  is  not  only  likely  but  quite  apparent,  that  the  very  extent 
of  the  task  would  have  bewildered  most  of  us  and  our  anxiety 
to  bring  some  order  out  of  chaos  would  have  made  us  overlook 
the  fine  and  most  essential  points  in  cavity  preparation.  All  of 
this  work  of  study  of  the  models,  and  stress,  the  making  of  the 
diagram,  the  taking  of  the  history,  etc.,  has  consumed  hour?, 
and  made  us  familiar  with  the  case.  If  we  omit  this,  the  case 
is  strange  to  us,  and  we  are  strange  to  the  case.  The  difficulty 
is  added  that  we  are  dealing  with  live  tissues,  and  we  are  unde- 
cided just  how  extensively  to  cut;  in  other  words,  we  do  not 
know  exactly  what  to  do.  But  if  we  have  made  the  careful 
study,  as  outlined  here,  and  if  we  have  cut  the  cavities  into  these 
teeth  as  our  knowledge  of  stress  conditions  and  immunity  areas, 
etc.,  tell  us  we  must;  and  if  we  have  planned  our  restorations 
upon  the  models  in  accordance  with  the  requirements  of  occlu- 
sion, and  phonetics,  and  harmony  and  proportion,  and  beauty, 
then  we  know  exactly  what  we  wish  to  do,  and  the  patient  pre- 
senting, we  proceed  to  do  just  that  thing. 

It  is  true,  we  may  be  hampered  and  interfered  with  by  con- 
ditions in  the  mouth  which  do  not  exist  on  the  models,  but  we 
bear  in  mind  our  result  on  the  model,  and  we  try  to  duplicate  it 
in  the  teeth,  removing  the  obstacle  as  it  presents  itself.  In  this 
way,  the  result  of  our  work  is  more  nearly  likely  to  approach 
our  ideal  of  our  task. 

It  is  quite  a  different  matter  to  cut  into  live  tooth  struc- 
ture than  it  is  to  cut  into  models,  and  often  the  ideal  is  very 
difficult  to  carry  out,  but  that  is  only  another  reason  that  the 
operator  should  approach  the  patient  only  after  a  complete 
and  exhaustive  study  of  the  case,  and  with  a  thorough  knowl- 
edge as  to  what  he  wishes  to  do  to  each  particular  and  individ- 
ual tooth,  remembering  always  that  the  ultimate  to  be  desired 
is  harmony  and  balance  in  the  relation  of  the  tissues  present  in 
the  oral  cavity. 

If  no  pain  or  putrescent  condition  be  present  to  urge  the 
operator's  attention  and  service  to  any  particular  tooth,  it  is 


EXTENSIVE    KKSTOKATIOXS    OK    OCCLTSAI,    15ALANCK  -4 1 

best  to  go  to  the  one  anteriorly  next  to  the  nearly  perfect  one, 
and  restore  that  to  anatomic  and  physiologic  balance;  then  the 
one  posteriorly  next  to  the  nearly  perfect  one  is  taken  care  of, 
and  third,  the  nearly  perfect  one  comes  in  for  attention.  In 
this  way  we  have  made  use  of  the  nearly  perfect  tooth  as  a 
guide  throughout  the  work.  It  has  determined  for  us  the  mesial 
extent  of  the  tooth  posteriorly  to  it,  and  the  distal  extent  of  the 
tooth  anteriorly  to  it.  It  lias  determined  for  us  the  occlnsal 
surfaces  of  the  two  teeth  with  which  it  occludes,  and  now  all  of 
the  teeth  that  have  been  restored  serve  as  a  guide  for  correct 
n  storation,  as  regards  mesio-distal  diameter  and  occlusal  sur- 
face of  the  nearly  perfect  organ. 

All  this  is  nothing  else  but  a  recognition  of  the  interdepend- 
ence of  all  media  which  enter  into  inseparable  relations  with 
one  another  to  create  a  perfect  organ  of  incision,  prehension, 
trituration  and  articulation. 

Doing  the  work  in  the  manner  described,  we  shall  have  the 
advantage  of  incapacitating  the  patient  on  one  side  of  the  mouth 
only,  and  thus  the  primary  processes  of  nutrition  will  not  be 
interfered  with,  and  we  shall  have  our  patient  more  tranquilly 
submissive  to  our  ministrations,  which  is  a  factor  conducive  to 
much  better  results  than  a  patient  nervously  tensioned  to  a 
high  pitch  and  querulous  opposition. 

When  one  side  from  molars  to  incisors,  upper  and  lower, 
has  been  restored,  the  other  side  is  taken  hold  of  and  treated 
in  much  the  same  manner  until  it  is  completed.  When  the 
case  is  finished,  two  plaster  impressions  are  obtained  and  models 
made.  The  record  models  are  marked  with  the  patient's  name, 
the  date,  and  /.'..I/. ,  standing  for  record  model.  The  study 
models  are  marked  S.M.,  and  the  last  models  are  marked  F.M., 
for  finished  models,  and  the  date  of  completion  of  the  same  All 
models  are,  of  course,  to  bear  the  name  of  the  patient. 

AVhen  the  loss  of  balance  in  mastication  is  due  to  other 
causes  than  poor  dental  work,  the  procedure  of  restoration  is 
markedly  different,  and  there  is  considerably  more  involved. 

We  shall  not  consider  the  cases  coming  under  heading  of 
traumatic  origin,  because  in  one  way  or  another  they  may  be 
handled  by  the  means  already  described,  or  as  yet  to  be  de- 
scribed. It  would  be  a  waste  of  time  to  devote  a  special  chap- 


242  CAST  GOLD  AXD  PORCELA1X  1XLAYS 

ter  to  restoration  by  means  of  inlays  of  tooth  tranmatically 
injured. 

Since  each  injury  would  probably  differ  from  every  other, 
the  case  would,  of  course,  present  a  different  history,  and  tho 
extent  of  the  injury  varying,  the  treatment  would  necessarily 
change.  "With  all  that,  these  cases  are  subject  to  the  same 
rules,  and  should  be  studied  quite  as  carefully,  if  not  more  so, 
than  the  ones  broken  down  by  poor  workmanship. 

So  we  shall  take  in  the  extensive  cases  of  traumatic  origin, 
under  the  heading  of  those  to  be  considered  as  being  due  to 
attrition,  in  reference  to  teeth. 

Attrition  is  the  act  of  wearing  down  the  teeth  by  mastica- 
tion, because : 

First:     The  patient  may  have  an  end-to-end  malocdusion. 

Second :  The  greatest  number  of  posterior  teeth  may  have 
been  lost  in  early  life,  and  the  entire  stress  of  mastication  is 
thrown  onto  the  remaining  anteriors;  which  stress  they  can  not 
resist,  and  hence  are  worn  down  by  attrition,  or 

Third:  The  osseous  system  of  the  patient  is  out  of  har- 
mony in  development  and  calcification  (hence  resistance),  with 
the  muscular  structure  of  the  same  patient.  In  other  words, 
there  is  a  predisposition  in  this  particular  case,  a  sort  of  phys- 
ical constitutional  inferiority,  osseously  speaking,  or  a  sort  of 
physical  constitutional  superiority,  muscularly  considered,  as 
you  please. 

Where  the  cases  are  most  extensive,  and  involve  the  entire 
masticatory  apparatus,  and  they  usually  do,  the  treatment  is 
much  the  same. 

These  cases  are  usually  between  thirty-five  and  fifty-five 
years  of  age.  By  this  I  mean  that  they  are  usually  thirty-five 
to  fifty-five  years  old  when  they  seek  relief. 

These  cases  are  so  extensive,  and  the  treatment  so  involved, 
and  so  much  depends  upon  a  favorable  prognosis,  that  no 
amount  of  care  given  to  these  restorations  can  be  said  to  be  too 
much.  The  treatment  is,  with  the  greatest  care,  quite  a  strain 
upon  the  patient's  nervous  system,  and  for  this  reason,  if  for 
no  other,  the  patient  should  be  directed  to  consult  a  careful 
internist,  a  diagnostician  of  the  first  rank,  and  a  report  should 
be  obtained  from  him  as  to  the  general  condition  of  the  patient. 


EXTKXSIYK    KKSTOIIATIOXS    OK    OCCI.l'SAI.    ]',ALA.\(  K  -4'.} 

To  a  large  extent  the  progress  of  the  dental  work  will  de- 
pend upon  the  report  handed  in  by  the  physician.  If  the  gen- 
eral condition  oi'  the  patient  is  such  that  he  can  withstand  the 
stress  of  protracted  dental  operations,  a  vigorous  program  may 
be  pursued  and  the  work  finished  in  a  much  shorter  time  than 
if  the  report  about  his  general  condition  were  to  necessitate 
careful  guarding  against  the  least  shock  to  the  nervous  system. 

It  is  wise  to  always  bear  in  mind  that  these  patients  have, 
by  virtue  of  the  very  condition  which  brings  them  to  us.  received 
an  impulse  which  started  them  down  hill  on  the  road  of  health, 
and  that  their  progn  ss  in  that  direction  must  be  checked  gently, 
but  efficiently. 

Usually  these  cases  are  complicated  by  peridental  irritation, 
or  even  active  suppuration  in  the  peridental  region. 

The  gingiva1  are  swollen,  congested,  bleed  readily,  and  mas- 
tication is  painful;  a  hypertrophy  of  the  alveolar  structure  of 
the  mandible  and  superior  maxilla.1  may  be  present. 

The  muscular  structure  of  the  temporo-maxillary  articula- 
tion will  be  found  overdeveloped,  if  at  all  out  of  the  ordinary. 
The  mandible  is  found  freely  movable  in  a  laterorotary  direc- 
tion. There  is  usually  present  a  variation  in  the  length  of  the 
posterior  teeth,  the  upper  ones  being  shorter  than  the  lower 
ones,  due,  no  doubt,  to  the  fixed  position  of  the  superior  maxilla? 
and  the  more  or  less  complete  passivity  of  the  teeth. 

Very  little,  if  any,  t  namel  is  present  upon  the  occlusal 
surfaces  of  the  posterior  teeth,  and  the  incisal  portions  of  the 
anteriors  are  altogether  devoid  of  it.  The  exposed  dentine  of 
the  anteriors  presents  a  highly  polished  appearance,  while  the 
occlusal  surface  s  of  the  posteriors  present  either  an  unevenly 
smooth  sin-face,  or  a  number  of  grooves  and  pits  corresponding 
in  location  to  the  normally  existing  fissures  and  sulci  in,  these 
teeth.  Most  of  these  cases  will  exhibit  a  reddish  stain  on  the 
occlusal  surfaces.  Knife-edged  occlusal  margins  are  the  rule. 

Regardless  of  the  fact  that  the  naso-mental  line  has  been 
gradually  shortened  during  the  years  in  which  this  process  of 
attrition  has  been  going  on,  we  shall  find  the  masseter,  and  tem- 
poral, as  well  as  buccinator  muscles,  tense  and  thickened,  prob- 
ably congested. 

We  shall   probably  find  these  patients  to  be  introspective 


244  ('AST    GOLD    AND    POIU'ELAIX    INLAYS 

to  the  point  of  melancholia,  uncommunicative,  and  often  eva- 
sive in  answering  questions,  difficult  to  enthuse,  and  they  are 
apt  to  confuse  technical  information  given  to  them  as  the  work 
progresses. 

They  are  often  irritable,  always  fidgety,  and  their  fingers 
are  usually  busy  doing  something,  if  only  playing  against  each 
other.  They  are  most  often  careless  in  their  manner  of  dress, 
and  usually  simple  in  their  food  requirements. 

From  several  of  these  cases  which  came  under  my  observa- 
tion and  care,  questioning  elicited  the  information  that  they  as 
a  rule,  shunned  the  opposite  sex.  The  foregoing,  plus  the  diag- 
nostician's report,  will  give  a  rather  comprehensive  picture  and 
history  of  these  patients. 

If  all  the  facial  lines  and  features  of  such  a  patient  are 
normal,  and  in  geometric  harmony,  the  deduction  that  the  masti- 
catory apparatus  was  in  proper  proportion  before  it  suffered 
from  the  attrition  is  permissible,  and  the  other  features  will  fur- 
nish the  means  of  determining  the  extent  to  which  this  process 
has  advanced. 

Any  photograph  the  patient  may  have  had  taken  years 
prior  to  his  visit  for  relief,  would  also  be  of  service  in  this 
respect. 

If  the  teeth  are  still  in  proper  mesio-distal  relation  to  one 
another,  only  the  occlusal  third  has  been  partially  or  totally 
obliterated. 

If  all  mesio-distal  relations  of  the  teeth  have  been  de- 
stroyed, and  if  the  features  of  the  patient,  such  as  fronto- 
orbital,  and  orbito-nasal  lines  be  unequal  to  any  great  extent, 
then  the  deduction  that  the  masticatory  apparatus  wras  out  of 
harmony  with  the  rest  of  the  features,  even  before  attrition  be- 
gan to  wear  the  teeth  down  is  permissible.  The  bulk  to  be 
added  to  the  teeth  becomes  a  matter  of  measurement  of  the 
various  features  and  experimentation.  Whichever  is  the  case, 
urgent  need  of  the  present  is  to  first  restore  the  gingival  and 
peridental  area  to  a  physiologic  condition,  take  care  of  any  root 
canal  work  which  may  be  necessarj^,  and  then  open  the  bite  by 
means  of  a  splint,  to  an  extent  at  least  double  that  which  seems 
to  be  necessr.ry. 

The  patient  must  wear  this  splint  incessantly  for  at  least 


KXTKXSIVK    KKSTOKAT10XS    <>!'    OCC'LTSAI.    IJALANTK  -4~) 

three  (lays.  Tins  must  be  insisted  upon,  and  in  order  to  help 
the  patient  over  his  trying  time,  lie  must  he  kept  very  busy 
during  the  day,  must  have  sleep  at  night,  even  if  the  sleep  is 
to  be  induced  by  hypnotics.  If  the  latter  are  employed,  they 
are  followed  by  the  use  of  laxative-. 

After  three  days  the  patient  is  allowed  to  remove  the  splint 
during  meal  time. 

The  strictest  hygienic  precautions  are  employed  in  keeping 
the  mouth  clean,  and  no  deviation  from  the  prescribed  regime 
is  permitted. 

It  must  be  remembered  that  this  is  a  re-creative  work  that 
is  going  on,  and  that  the  operator  is,  if  he  has  the  necessary 
intelligence,  in  truth  a  creator  of  a  real  primary  factor  in  the 
human  economy.  The  patient  must  be  made  to  realize  this  for 
his  or  her  own  ultimate  good. 

Never  before,  in  the  history  of  human  error,  has  it  been 
possible  to  so  utterly  wipe  out  every  evidence  of  this  dental 
shortcoming  as  it  is  today.  It  is  very  likely  that  even  the  minds 
that  conceived  this  entire  process  of  cast  gold  inlays,  never  fully 
realized  the  extent  of  the  blessings  the  process  might  bring  and 
but  for  this  process  our  work  in  these  cases  would  be  today  as 
it  has  been  in  the  past — nothing  but  a  poor  palliative  effort,  full 
of  nothing  so  much  as  futility. 

CONSTRUCTION  OF  THE  SPLINT 

Plaster  impressions  are  obtained  from  the  upper  and  lower 
jaw,  and  models  are  made.  Three  layers  of  number  .001  tin  foil 
are  burnished  over  the  upper  model,  taking  in  the  crowns  of  the 
posterior  teeth  and  extending  up  to  the  gingival  surface  of  them 
and  beyond,  and  as  far  back  toward  the  palate  as  a  plate  made 
for  the  case  would  be  allowed  to  go. 

All  of  the  palatal  surface  of  the  foil,  as  well  as  the  part 
covering  half  of  the  palatal  surfaces  of  the  teeth,  is  covered 
with  a  sheet  of  baseplate  wax  of  medium  thickness. 

The  balance  of  the  palatine  surfaces  of  the  teeth  and  the 
occlusal  surface  upon  the  four  posterior  teeth  is  covered  with 
three  or  four  layers  of  the  same  baseplate  wax  and  the  buccal 
surface  of  the  foil  upon  the  posterior  teeth  is  coated  with  one 


246  CAST  GOLD  AND  PORCELAIN  INLAYS 

layer  of  the  wax,  which  layer  is  to  reach  over  and  onto,  and 
be  melted  into,  the  three  or  four  layers  of  the  occlusal  waxes. 
This  wax  must  he  marginally  melted  onto  the  foil,  so  that 
when  the  former  is  removed  from  the  model,  the  foil  will  come 
with  it. 

The  wax  is  trimmed  to  proper  outline,  and  a  surplus  of  foil 
is  allowed  to  remain,  which  may  he  folded  hack  on  the  wax. 
Tliis  contrivance  is  chilled  in  ice  wTater,  and  placed  in  the  pa- 
tient's mouth  for  determination  as  to  occlusal  thickness.  It  is 
removed  and  replaced  upon  the  model,  a  layer  of  soft  wax  is 
placed  upon  the  occlusal  surface  and  melted  onto  it,  so  that  we 
shall  have  a  layer  of  wax  upon  that  surface  about  one-half 
inch  thick.  The  plate  is  again  inserted  into  the  mouth,  and  the 
patient  is  admonished  to  swallow  and  close  the  teeth.  The  re- 
sulting impression  of  the  lower  teeth  on  the  wax  will  furnish 
the  necessary  guide  to  place  the  lower  model  into  proper 
position. 

This  is  done,  and  two  pieces  of  wood,  reaching  across  from 
model  to  model,  are  waxed  onto  each  model,  and  they  are  placed 
in  the  anatomic  articulator.  When  the  plaster  has  set,  the  ad- 
justment screw  is  fixed,  the  surplus  of  the  plaster  is  trimmed 
off,  the  two  pieces  of  wood  are  removed,  the  articulator  opened, 
and  the  wax  and  tin  foil  are  carefully  removed  and  laid  aside. 

A  careful  preliminary  study  of  the  models  should  now  take 
place;  undercuts  which  may  interfere  with  the  placing  of  the 
splint  should  be  filled  up,  or  otherwise  obliterated. 

The  lower  model  is  covered  with  a  layer  of  tin  foil,  the 
articulator  is  closed,  and  the  space  between  the  models  is  grad- 
ually reduced  until  they  meet.  In  this  position  they  should  be 
viewed  from  every  angle;  the  size  of  the  teeth  is  carefully  noted 
as  regards  circumference,  and  the  models  are  separated  to  al- 
low for  a  height  of  tooth  in  proportion  to  this  circumference. 
It  must  be  borne  in  mind  that  these  approximate  measurements 
must  be  double,  since  we  have  both  models  upon  the  frame. 
Having  opened  the  articulator  to  about  the  extent  required,  we 
simply  open  it  again  as  much,  so  that  if  Mo  of  an  inch  be  miss- 
ing off  the  lower  teeth,  and  Mr,  to  %z  off  the  upper  teeth,  we 
would  have  opened  the  articulator  Mo  +  Mo  and  '%%  +  Me  + 
Mo  +  Vs2,  or  'Kc  of  an  inch.  In  this  condition,  the  articulator 


KXTKXSIYK    KKSTOKATIOXS    ()!     (KVH'SAL    IJALAXCE  -4 1 

.is  fixed  so  that  the  space  may  not  accidentally  be  reduced  or 
raised. 

There  is  a  irood  sound  reason  for  opening  the  articulator 
to  double  the  extent  which  the  attritional  wear  calls  for  ami 
that  is  that  it  will  lead  to  a  muscular  adjustment  in  the  temporo- 


Fig.   193.  Fig.   194. 

FIL;.  193. — A  view  of  a  splint  made  for  a  case  of  extensive  restoration. 

Fiy.  194. — Another  view  of  the  same  splint  which,  when  it  was  first  made  and 
worn,  covered  all  the  anterior  portion  of  the  jaw,  as  well  as  the  part  now  occu- 
pied by  it. 


Fig.  195. 

Fig.   193. — The   splint  in  position   on  the   model.     Note  the  amount  of  space 
created  between  upper  and  lower  teeth;  twice  as  much  as  is  really  needed,  for  reasons 

explained   elsewhere. 

mandibular  articulation,  far  beyond  that  necessary  for  simple 
toleration  of  the  work  when  completed,  and  so  the  completed 
work  IHMH.U;  much  lower,  gingivo-occlusally,  than  the  splint,  the 
sensation  the  patient  will  experience  upon  removal  of  splint 


248  CAST    COLD    AND    PORCELAIN    INLAYS 

and  insertion  of  tlie  work,  will  he  one  of  great  relief;  and  tlie 
muscles  having  been  adjusted,  and  liaving  become  more  or  less 
accustomed  to  the  additional  amount  of  stretch  will  find  an 
enjoyable  relaxation  in  being  permitted  to  flex  into  a  much  less 
tense  position.  The  tendency  of  too  great  and  hence  destructive 
muscular  stress  upon  the  newly  placed  work,  will  in  this  manner 
be  wholly  avoided. 

The  wax  plate  backed  or  lined  with  tin  foil  is  replaced  upon 
the  upper  model,  the  wax  is  softened  somewhat,  and  a  close 
adaption  of  it  to  the  model  is  brought  about.  Enough  soft  wax 
is  added  to  the  occlusal  surface  to  take  up  the  space  created  by 
the  opening  of  the  articulating  frames,  and  a  surplus  is  added 
so  that  the  teeth  of  the  lower  model  may,  upon  the  closing  of  tlie 
articulator,  bury  themselves  in  the  soft  wax  upon  the  occlusal 
surface  of  the  splint. 

The  foil  present  upon  the  lower  model  will  prevent  the 
sticking  of  it  to  the  wax,  and  we  shall  have  a  more  or  less  accu- 
rate impression  of  the  lower  teeth,  as  a  guide  to  aid  in  carving 
up  the  occlusal  surface  of  the  splint. 

The  external,  or  buccal,  surfaces  of  the  wax  splint  must 
be  allowed  to  reach  over  and  enclose  the  buccal  surfaces  of  the 
lower  posterior  teeth,  so  that  when  the  splint  is  duplicated  in 
vulcanite,  it  will,  when  worn  by  the  patient,  prevent  effectively, 
first,  the  biting  of  the  soft  tissues,  and  second,  the  latero-rotary 
motion  of  the  mandible. 

This  will  aid  in  the  fixation  of  the  muscles  and  compel  the 
patient  to  exercise  a  more  pronounced  intra  pressure  upon  the 
teeth,  which  will  have  a  stimulating  or  rather  toning  effect  upon 
the  peridental  and  gingival  tissues. 

In  carving  up  the  occlusal  surfaces  of  the  splint  in  the  wax, 
the  anterior  teeth,  upper  and  lower  are  left  free  from  any  in- 
cumbrance,  and  the  entire  stress  is  thrown  upon  the  posterior 
teeth,  upper  and  lower. 

The  splint  is  removed  from  the  model,  Masked  and  vulcan- 
ized and  finished  off,  when  it  is  ready  to  insert  into  the  patient's 
mouth.  After  having  been  worn  for  three  or  four  days,  the  ex- 
ternal or  buccal  overhanging  plates  may  be  considerably  short- 
ened, or  even  removed,  and  it  will  be  found  that  the  tendency 
for  too  free  a  lateral  motion  will  have  diminished  to  a  great 


EXTKNSIVK   I;KSTOI;ATIOXS  OK  QCCLUSAL  I--ALAXCK  1'4!) 

degree;  it  will  still  be  present,  hut  will  not  manifest  itself  until 
after  considerable  pressure  lias  l)eeti  spent  upon  the  teeth  ill  an 
intra  direction. 

The  patient  must  wear  this  splint;  but  it  may,  if  so  desired, 
be  removed  at  meal  time  and  at  night,  although  it  may  be  worn 
by  the  patient  during  the  night  without  fear  of  mishap,  if  it  lias 
been  carefullv  constructed. 

The  models  from  which,  or  upon  which,  the  splint  was  made, 
are  kept  as  record  models.  After  the  splint  lias  been  worn  four 
days  to  one  week,  plaster  impressions  are  obtained  and  study 
models  are  made. 

The  models  are  diagrammed,  and  the  charts  of  stress  direc- 
tion are  made.  The  models  are  brought  into  occlusal  relation 
as  it  exists  in  the  mouth;  this  may  be  done  by  means  of  a  wax 
bite,  or  if  any  pronounced  landmarks  be  present,  these  may  be 
used  as  a  guide. 

The  models  are  then  mounted  upon  the  adjustable  articu- 
lating frame,  the  cavities  may  now  be  outlined  and  even  formed 
in  the  plaster  casts,  keeping  in  mind  that  we  are  working  to 
restore  the  teeth  to  usefulness  and  anatomic  perfection,  and  to 
restore  to  original  dimensions  the  naso-im  ntal  line. 

If,  as  said  before,  the  rest  of  the  features  are  in  harmony 
with  one  another,  the  conclusion  that  the  naso-mental  distance 
was  originally  normal  relative  to  these  features,  is  permissible, 
and  if  the  remaining  features  are  out  of  harmony  and  propor- 
tion, then  a  naso-mental  line  which  will  be  least  obtrusive  is 
produced.  The  average  measurements  for  the  normal  face,  as 
determined  by  sculptors  and  artists  for  the  past  ages,  give  the 
naso-mental  line  as  ^:!4  inches  long  and  the  length  of  the  normal 
nose  as  1%  of  an  inch.  The  normal  upper  lip  when  the  mouth 
is  closed  is  %  of  an  inch.  The  length  of  the  nose  is  obtained 
by  drawing  a  horizontal  line  through  the  center  of  the  pupils 
of  the  eyes  and  dropping  a  perpendicular  from  that  line  to  the 
tip  of  the  nose. 

The  normal  face  from  the  center  of  the  pupils  should  give 
the  diagrammatic  reading  as  illustrated. 

The  naso-mental  line  of  the  patient  is  taken  and  noted  down 
on  the  articulator  and  record  and  study  models,  as  well  as  the 
history  chart.  It  will  naturally  be  found  that  the  length  of  the 


250  CAST  GOLD  AND  POKCELAIN  INLAYS 

line  varies  inversely  with  the  extent  to  which  the  process  of 
attrition  has  progressed,  that  is,  the  greater  the  attrition,  the 
shorter  the  line. 

For  the  purpose  of  lucid  illustration,  we  will  assume  that 
the  naso-mental  line  of  the  patient  is  2!/>  inches  long,  which  in 
a  normal  featured  individual  is  %  inch  longer. 

The  articulating  frame  supporting  the  models  may  now  he 
opened  until  the  models  are  /4  inch  apart  occlusally,  and  the 
frame  may  be  fixed  in  this  position. 

This  would  be  a  fairly  accurate  manner  of  determining  the 
ultimate  amount  of  space  necessary  to  be  gained  in  order  to 
restore  the  lost  featural  balance,  but  for  the  restoration  of  oc- 
clusal  balance  much  greater  care  is  required. 

Four  pieces  of  German  silver  plate,  30-gauge,  are  swaged 
up  to  cover  the  posterior  teeth  of  both  the  upper  and  lowTer 
models  down  to  one-half  of  their  length.  They  are  filed  and 
polished  so  as  to  present  smooth  surfaces  and  margins  to  the 
tongue  and  cheeks. 

The  occlusal  surfaces  are  roughened,  slightly  heated,  and 
covered  with  a  layer  of  wax  /4  inch  thick,  each  piece  of  metal 
carrying  the  more  or  less  soft  wax  and  placed  into  its  respec- 
tive position  within  the  mouth.  A  hot  instrument  is  drawn 
across  each  wax  surface,  the  patient  is  directed  to  place  the 
tongue  upon  the  roof  of  the  mouth,  to  swallow  and  close  the 
mouth.  A  piece  of  hard  rubber  or  hard  wood  or  metal  %  inch 
in  thickness  is  held  between  the  anterior  teeth,  to  prevent  too 
great  a  pressure  from  being  exercised  upon  the  wax;  the  lat- 
ter is  chilled,  and  the  upper  and  lower  metal  plates  will  be 
found  to  adhere  through  the  medium  of  the  wax.  This  will 
really  produce  two  partial  splints  which  must  now  be  so  em- 
bedded in  a  refractory  compound,  that  the  metallic  plates  will 
be  immovably  held,  while  one  surface  of  the  wax  shall  be  ex- 
posed so  that  all  of  it  may  be  removed  by  boiling  the  piece  in 
water. 

The  space  thus  produced  between  the  two  plates  of  metal 
may  be  filled  with  several  pieces  of  German  silver  wire,  the 
whole  of  it  fluxed  and  soldered  with  tin  until  they  present  a 
fairly  full  appearance  and  smooth  surface. 

These  metallic  plates  are  now  joined,  each  lower  to  its  cor- 


EXTENSIVE    RESTORATION  S    ol     (KVl.rsAL    IJALANCK  -~}\ 

responding  upper  section,  are  removed  from  tlie  investment 
compound,  finished,  and  polished  and  placed  into  the  mouth; 
the  patient  is  directed  to  close  the  mouth,  and  it  will  he  found 
that  the  naso-mental  line  is  now  2%  inches  long  instead  of  2% 
inches. 

Of  late  I  have  joined  these  plates  by  vulcanizing  rubber 
between  and  onto  them,  in  which  case  the  occlusal  surfaces  of 
these  plates  must  be  considerably  roughened,  so  that  the  rub- 
ber will  adhere. 

The  parts  of  one  partial  splint  which  covers  the  first  upper 
and  lower  molars  and  the  second  bicuspids  are  cut  out  with 
a  burr  and  saw;  this  will  leave  one  partial  splint  fitting  over 
the  last  molars  and  first  bicuspid. 

AYe  are  now  in  a  position  to  begin  the  reconstruction  of  the 
first  molars  and  the  second  bicuspids. 

If  the  teeth  are  still  in  normal  mesio-distal  relation,  then 
the  amount  of  building  up  to  be  done  is  easily  determined,  if 
we  consider  the  following:  From  the  gingival  line  up  toward 
the  occlusal  surface,  a  tooth  may  be  divided  into  three  parts 
horizontally,  which  will  give  a  gingival  third,  a  middle  third, 
and  an  occlusal  third. 

The  mesio-distal  relation  of  posterior  teeth  takes  place  at 
the  greatest  circumference  of  these  teeth,  and  the  greatest  cir- 
cumference of  these  teeth  is  invariably  to  be  found  at  the  gin- 
gival plane  of  the  occlusal  third. 

The  teeth  of  the  case  in  hand,  being  in  mesio-distal  relation, 
we  conclude  that  only  the  occlusal  third  or  less  has  been  de- 
stroyed by  attrition.  AYe  measure  the  remaining  portion  of  the 
teeth,  gingivo-occlusally,  divide  the  result  in  half,  and  we  know 
how  high  the  tooth  should  be  when  restored;  this  is,  of  course, 
to  be  done  before  any  cavity  preparation  is  attempted. 

If  the  mesio-distal  relation  of  the  teeth  has  been  lost  be- 
cause of  this  process  of  attrition  or  otherwise,  the  following 
rules  will  have  to  be  borne  in  mind  when  we  are  engaged  in  the 
correct  restoration  of  these  teeth. 

If  every  surface  of  a  molar,  except  the  occlusal  surface, 
be  ground  at  right  angles  to  the  gingival  plane  of  the  gingival 
third,  in  other  words,  if  taking  the  circumference  of  the  gin- 
ival  plane  of  the  gingival  third  as  a  guide,  we  ground  the 


252 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Fig.  196. 


Fig.  197. 


Fig.  19S. 


Fig.  199. 


EXTENSIVE    IlKSTOKATIOXS    OK    (HVM'SAL    UALAXCK  2.").'} 


Fig.  196. — An  occlnsal  view  of  the  models  of  the  same  case, 
the  terrible  havoc  wrought  by  neg'ert,  misunderstanding,  and 
poor  work  may  be  more  plainly  seen.  Note  carefully  the  evidence 
of  marked  congestion  in  th:>  gingival  region  of  the  mandible.  All 
of  the  upper  and  lower  anteriors,  cuspids  included,  were  putrcs- 

CCIlt. 

Fig.  197. — The  model  of  the  upper  teeth  of  case  after  six 
months'  treatment.  The  roots  have  been  placed  in  a  healthy 
condition  and  are  carrying  cast  base  crowns.  A  removable  bridge 
supplies  the  missing  teeth  on  the  right  side  of  the  mouth,  cuspid 
and  molar  serving  as  abutments. 

Fig.  198. — The  lower  model  showing  c'early  the  rebuilding 
of  the  anterior,  and  some  of  the  posterior,  teeth  by  means  of  the 
cast  gold  inlay  and  cast  base  crowns. 

Fig.  199. — The  upper  and  lower  models  in  occ'usion.  Note 
the  increase  in  space  on  left  side,  of  the  mouth,  for  which  the 
bridge  has  not  yet  b;cn  made.  Note  the  difference  in  appearance 
of  the  gingival  areas.  ** 


254  CAST  GOLD  AND  PORCELAIN  INLAYS 

walls  of  the  tooth,  so  that  a  wire  measurement  taken  around  the 
gingival  circumference  will  pass  easily  up  and  down  upon  the 
teeth,  we  would  find  that  the  highest  point  of  the  occlusal  emi- 
nences were  in  line  with  some  point  on  the  gingival  circumfer- 
ence. 


Fig.  200. — An  occlusal  view  of  a  finished  case  of  extensive  restoration  by 
means  of  cast  gold  inlays  and  two  upper  bridges.  All  lower  teeth  clistally  to  the 
cuspids  have  been  restored  with  inlays.  The  anterior  teeth  have  been  built  up  with 
cast  base  porcelain  crowns. 


Fig.  201. — A  side  view  of  the  same  case — upper  and  lower  models  in  occlusion. 
Note  here  the  added  length  of  the  teeth  as  compared  with  the  models  before  work 
was  started.  The  length  of  the  naso-mental  line  was  increased  %o  inch. 

Now  if  we  bear  in  mind  the  fact  that  the  greatest  circum- 
ference of  the  tooth  is  at  the  gingival  plane  of  the  occlusal 
third,  and  then  form  a  right-angled  triangle,  the  base  of  which 
is  formed  by  a  line  dropped  from  the  highest  occlusal  eminence 
to  a  point  of  intersection  with  the  line  rising  from  the  gingival 


EXTENSIVE    RESTORATION'S    OK    OCCLl'SAI.    I1AI.AXCK 


circui&Cerence,  to  the  gingival  plane  of  tlio  occlusal  third,  the 
latter  is  the  line  of  altitude  of  the  right-angled  triangle,  while 
its  hypothenuse  is  I'onned  by  the  direct  line  dropped  from  the 
occlusal  eminence  to  the  gingival  circumference  as  illustrated 
(1-8,  Fig.  203)  on  the  chart. 

This  holds  good  for  the  contouring  of  the  four  surfaces  of 
the  tooth,  in  the  case  of  these  restorations,  the  surfaces  being 
practically  intact  with  the  exception  of  portions  of  proximal 
areas.  The  following  geometric  drawing  will  aid  in  determin- 


Litu  flvroujfo. 


V5/3  incHe5  lon>«r  Up 


Fig.  202. 

ing  definitely  the  extent  of  the  mesio-distal  restoration  re- 
quired to  obtain  a  normal  contact  area  between  the  teeth  mcsio- 
<  list  ally. 

The  figures  enclosed  by  the  letters  BCEF  and  KHOP 
(Fig.  203)  show  two  central  cubes  of  two  adjoining  teeth,  as 
they  would  rise  minus  any  contour  from  the  gingival  plane  of 
the  gingival  third  of  the  tooth.  In  adding  the  proper  contour 
mesio-distally,  the  mesio-proximal  triangle  ELF  of  the  pos- 
terior tooth,  dips  or  extends  into  the  disto-proximal  triangle 


256 


CAST    GOLD    AXI)    PORCELAIN    INLAYS 


bfl 


KXTKNSIVK    KKSTOKATIONS    OK    OCCl.l'SA  I .    MA  I  .A  \( 'K 


Fig.    I'n:;. 

It  must  IK-  borne  in  mind  that  this  chart  represents  a  tooth 
geometrically.  It  is,  therefore,  conventionalized.  A  variation 
presents  itself  in  the  location  of  the  right  angles,  as  follows: 

In  upper  molars  the  right  angle  presents  at  the  gingival  plane 
of  the  occlusal  third  buceally,  and  the  gingival  plane  of  the  middle 
third  palatally. 

In  lower  molars  the  right  angle  presents  at  the  gingival  )>lane 
of  the  middle  third  buccally.  and  at  the  gingival  plane  of  the 
occlusal  third  lingually. 

Furthermore,  if  we  lay  out  the  respective  right  angles  of  the 
upper  and  lower  molars  and  continue  the  bases  and  altitudes  until 
they  intersect,  we  will  produce  squares  with  sufficient  variations 
in  their  lines  of  direction  to  account  for.  and  to  coincide  with,  the 
rhomboidal  and  trape/oidal  figures  of  the  gingival  planes  of  the 
gingival  thirds  of  the  respective  teeth. 

Fig.   1. — Molar  crown   divided  horizontally  into  thirds. 
J.I.   Occlusal  third. 
BB.  Middle  third. 
CC.  Gingival   third. 

Fig.   i'.-    Same,  with  thirds  separated. 

AA.  Gingival  plane  of  occlusal  third. 
BB.  Occlusal  plan^  of  middle  third. 
CC.  Gingival  plane   of  middle  third. 
DD.  Occlusal   plane   of  gingival  third. 
EE.  Gingival  plane  of  gingival  third. 

Fig.  3. — Geometric  construction  of  contours  of  molars.  A 
line  drawn  from  highest  eminence  of  cusp,  to  a  point  on  the 
circumference  of  the  tooth  at  its  neck  (XT),  becomes  the  hypothe- 
nuse  of  a  right-angled  triangle  (XYZ),  the  right  angle  of  which 
will  lie  opposite  the  gingival  plane  of  the  occlusal  third.  XYZ, 
the  right-angled  triangle.  XY,  the  hypothenuse.  XZ,  base  of 
triangle.  A')",  altitude  of  triangle. 

Fig.  4. — Geometric  solid  figure,  properly  triangulated,  from 
which  molar  crown  may  he  carved. 

Fig.  5. — Same  with  component  sections  separated.  A.  Cen- 
tral rectangular  pillar.  B.  Mesial  wedge-shaped  section.  C.  Lin- 
gual wedge.  D.  Distal  wedge.  E.  Buccal  wedge.  F.  Mesio-buccal 
angle  section.  Triangular  pyramid  inverted.  G.  Mesio-lingual 
pyramid.  H.  Disto-lingual  pyramid.  I.  Disto-buccal  pyramid. 

Fig.  6. — Geometric  figure,  showing  second  stage  of  carving 
molar  crown,  the  cusps  appearing  as  quadrangular  pyramids. 

Fig.  7. — Third   stage.     One-half  of  crown   carved   out. 

Fig.  8.— Crown  completed. 


258  CAST  GOLD  AND  PORCELAIN  INLAYS 

KMH  of  the  anterior  tooth,  in  such  a  manner  that  a  quadri- 
lateral figure  IMJL  is  formed. 

If  a  perpendicular  line  HG  is  dropped  between  the  two 
teeth,  it  will  bisect  this  quadrilateral  figure,  and  will  also  be 
tangent  to  the  two  arcs  UV  and  ST  both  arcs  being  parts  of 
two  circles  the  centers  of  which  lie  externally  to  the  two  teeth 
involved. 

In  the  former  chart  of  geometric  tooth  construction  within 
the  two  triangles  XYZ  is  seen  a  dotted  line  indicating  the 
approximal  contour  of  a  molar  tooth,  and  by  studying  the  two 
charts,  the  student  will  know  how  to  determine  the  extent  to 


Tig.  204. — The  figures  enclosed  by  the  letters  BCEF  and  KNOP  show  two  cen- 
tral tubes  of  two  adjoining  teeth  as  they  should  appear  when  dressed  down  to  receive 
crowns.  The  mesio-proximal  triangle  ELF  of  the  posterior  tooth,  dips,  or  extends 
into  the  disto-proximal  triangle  KMN  of  the  anterior  teeth  in  such  a  manner  that  a 
quadrilateral  figure  IMJL  is  formed.  If  a  perpendicular  line  HG  is  dropped  between 
the  two  crowns,  it  will  bisect  this  quadrilateral  figure  and  will  also  be  tangent  to 
the  two  arcs  UV  and)  ST,  both  arcs  being  parts  of  two  circles,  the  centers  of  which 
lie  externally  to  the  two  teeth  involved. 

which  his  approximal  contour  line  should  lie  within  that  tri- 
angle at  the  point  of  approximal  contact. 

When  with  a  view  to  all  factors  involved  (diagrams  of 
stress  and  contour),  immunity  and  re-creation  of  balance,  the 
cavities  in  the  first  molars  and  second  bicuspids  have  been  pre- 
pared, and  the  inlays  completed  and  cemented  into  place,  all 
of  which  was  done  while  the  partial  splint  remained  in  position 


EXTENSIVE    IlESTOIiATIOXS    OK    ( >C( 'I.CSA  I.    |;.\  I  .A  N  t 'K 


259 


Fig.  205. 

Fig.  1  is  a  horizontal  section  representing  the  occlusal  plane  of  tho  middle 
third  of  an  upper  second  bicuspid.  The  heavy  curved  lines  within  the  circle  repre- 
sent the  mesial  and  distal  surfaces,  while  the  dotted  curved  lines  indicate  the  form  and 
proportionate  height  of  the  buccal  and  lingual  cusps.  ABC  is  an  isosceles  triangle 
which  has  the  line  AB  as  the  base,  and  the  lines  AC  and  CB  the  respective  sides. 
The  angle  ACE  is  the  apical  angle,  and  being  bisected  by  the  line  CD,  this  same  line 
will  also  bisect  the  lingual  cusp  of  the  upper  second  bicuspid. 


Fig.  2  is  a  horizontal  section  representing  the  occlusal  plane  of  the  middle  third 
of  a  lower  second  bicuspid.  The  heavy  curved  lines  within  the  circle  represent  the 
mesial  and  distal  surfaces,  while  the  dotted  curved  lines  represent  approximately 
the  buccal  and  two  lingual  cusps.  EGF  is  an  isosceles  triangle,  with  the  line  EF  as 
the  base,  and  the  lines  EG  and  FG  as  the  respective  sides.  Tho  angle  EGF  is  the 
apical  angle,  and  being  bisected  by  the  line  GH,  the  same  line  will  also  bisect  the 
Iniccal  cusp  of  the  lower  second  bicuspid. 


260  CAST    (10L!)    AND    POIH'KLAIX    IX  LAYS 

on  the  opposite  side  of  the  mouth,  supplying  the  definite  height 
to  which  the  teeth  being  restored  were  to  be  raised,  that  part 
of  the  rubber  splint  fitting  over  and  around  the  restored  area 
is  eased  so  that  it  may  go  to  place  and  rest  upon  the  teeth  not 
yet  rebuilt. 

An  additional  section  of  the  partial  splint,  belonging  to 
the  side  in  the  process  of  restoration,  is  now  removed  with  a 
fine  saw;  enough  is  cut  out  so  that  the  second  molars,  upper 
and  lower,  may  be  worked  upon.  When  these  are  finished,  the 
rubber  splint  is  eased  up  at  these  areas,  and  the  partial  splint 


Fig.  206. — Showing  how  perfectly  occlusal  surfaces  may  be  carved  in  the  wax 
and  reproduced  by  means  of  the  casting  process.  Here  the  left  upper  first  molar 
has  been  exactly  copied  and  reproduced  in  gold.  (Dr.  J.  Lowe  Young.) 

for  that  side  may  be  put  away  as  part  of  the  record  of  the  case, 
and  the  first  bicuspid  cavities  may  be  prepared  and  inlayed. 
The  rubber  splint  is  adjusted  to  make  it  conform  to  the  new 
conditions  by  removing  all  of  the  occlusal  surface  of  it  on  that 
side. 

It  is  then  placed  in  the  oral  cavity  and  the  space  previously 
occupied  by  the  cut  end  section  is  filled  with  a  roll  of  yellow 
wax,  the  patient  is  directed  to  close  the  mouth  until  the  teeth 
on  the  other  side  are  in  occlusal  relation  with  the  splint.  A 


K   I;I;STOI;ATIOXS  OF  OCCLTSAI,  IIAI.AXCK  1'lil 

few  minutes  arc  allowed  Tor  the  wax  to  liarclen.  The  splint  is 
removed,  (lasked,  cleaned,  packed,  vulcani/ed,  and  polished.  It 
is  returned  to  the  patient  at  the  next  sitting,  when  the  procedure 
of  restoration  is  again  stalled  with  the  iii>t  molars  and  second 
bicuspids  of  the  opposite  side. 

At  this  point  we  may  dispense  altogether  with  the  remain- 
ing partial  splint,  the  opposite  side  giving  a  reliable  occlusal 
guide. 

Thus  we  go  to  the  second  molars  and  third,  if  any  he  pres- 
ent, and  finally  to  the  first  bicuspids,  easing  the  rubber  splint 
from  time  to  time  until  the  first  bicuspids  have  been  fully  re- 
stored, when  the  rubber  splint  may  also  be  dispensed  with.  We 
shall  iind  now  that  the  naso-mental  line  has  increased  in  length, 
that  the  posterior  teeth  are  in  normal  inesio-distal  relation,  and 
that  we  have  re-created  an  occlusal  balance  of  the  posterior  part 
of  the  masticating  apparatus  which  will  leave  nothing  to  be  de- 
sired, and  the  perfection  of  which  we  never  could  have  even  ap- 
proached without  the  help  of  the  casting  process. 

The  following  is  a  quotation  from  an  editorial  written  for 
the  Dental  Items  of  Interest,  May,  1913,  by  Dr.  Ottolengui,  an 
editorial  which  has  the  distinction  of  being  timely  and  true. 

"In  the  past  we  have  contoured  teeth,  but  we  have  not  con- 
toured them  to  the  extent  implied  by  the  word  'restore.' 

"The  contourists  have  replaced  corners,  have  built  up  in- 
cisal  edges  with  fair  accuracy,  and  they  have  even  rounded 
out  the  approximal  or  circumferential  shapes  of  teeth.  Hut 
/lie  i/  Jwve  woefully  failed  to  even  fairly  well  i  mil  ate  the  occlusal 
surfaces  of  hienxpid*  and  molar*. 

"Perhaps  never  until  now  has  the  dental  world  been  fully 
aroused  as  to  the  importance  of  restoring  occlusion.  The  or- 
thodontist and  the  prosthodontist  have  far  outstripped  the  den- 
ists  in  this  respect,  but  the  time  has  now  arrived  when  the  den- 
tist  must  awaken  and  grasp  the  need  of  making  occlusion  the 
fundamental  principle  of  everyday  work. 

"  Any  child  would  tell  us  'teeth  are  made  to  eat  with.'  The 
great  Master  so  formed  these  organs  that  they  would  not  only 
'eat,'  but  'cat'  well.  The  slightest  loss  of  any  part  of  the 
masticating  surface  of  a  tooth,  the  most  minute  change  in  its 
designed  form,  diminishes  its  usefulness  as  a  masticatory  or- 


CAST    GOLD    AXD    PORC'HLAIX    IXLAVS 


Fig.  207. 


Fig.   208. 


EXTKNS1YK    KKSTOKATIOXS    OF    OCVIA'SAL    I5ALAXCH 


263 


Fig.  209. 


Figs.  207,  208,  and  209. — Three  illustrations  of  beautiful  oc- 
dusal  surfaces.  Two  lower  models  above,  and  one  upper  model 
below.  Note  carefully  the  second  lower  bicuspids  and  second 
upper  bicuspid.  Note  also  the  continuity  of  the  disto-buccal  cusp 
of  the  first  upper  molar  with  the  mesio-lingual  cusp.  (Dr.  J. 
Lowe  Young.) 


>64 


CAST  GOLD  AXD  PORCELAIN  IXLAVS 


gaii  to  just  that  extent.  Reversely,  where  part  or  all  of  the 
occlusal  surface  of  a  tooth  is  lost  through  caries,  the  more 
nearly  the  dentist  succeeds  in  restoring  its  original  form,  the 
more  perfect  does  he  make  the  patient's  ability  to  masticate 
food. 

"Hundreds  of  articles  have  been  written  upon  the  need  of 
restoring  approximal  contact  as  a  protection  to  the  gingiva 


Fig.  210. — Note  the  two  illustrations  011  the  lower  portion  to  the  left,  with  their 
inefficient  occlusal  surfaces,  and  compare  the  four  other  illustrations  with  their 
definite  sulci,  cusps,  and  fissures. 

which  normally  nils  the  interproximal  space;  but  a  close  study 
of  the  anatomy  of  the  region  will  demonstrate  that  the  con- 
tact of  adjacent  teeth  is  only  one  of  Nature's  measures  for  the 
protection  of  the  gingiva,  and  not  the  most  important.  At  the 
approximal  margin  of  the  occlusal  surface  of  molar  or  bi- 
cuspid will  be  found  a  marginal  ridge  with  its  most  slanting 
plane  extending  around  the  center  of  that  surface,  and  there- 


EXTENSIVE    UESTOItATIONS    OF    OCCLFSAL    I'.ALANCK 


Fig.  211. — This  illustration  .-ind  Fig.  212  are  shown  to  call  to  mind  the  ways 
in  which  attrition  manifests  itself  in  different  types. 

Note  in  this  illustration  a  great  amount  of  attrition,  and  yet  very  well-defined 
and  rathi-r  deep  occlusal  plones.  Note,  also,  to  tlie  right  a  malposition  of  the  bicus- 
pids and  a  consequent  narrowing  of  the  arch.  This  may  be  called  a  thyro-adrenal 
tooth.  It  is  the  tooth  of  the  dreamer,  the  poet,  and  highly  artistic  architect,  the 
landscape  gardener,  the  artist,  more  so  the  impressionist,  people  of  culture,  and  us- 
ually people  of  :_;roat  sincerity. 


Fin'.  -1-. — Another  type  of  the  result  of  attrition.  The  cusps  and  planes  arc 
not  so  deep,  not  so  well  defined  and  the  arch  is  wider.  It  is  the  pituito-gunado- 
adrenal  type.  It  belongs  to  the  individual  who  lives  in  conformity  to  form, — works 
fiyht  hours,  sleeps  eight  hours,  and  plays  eight  hours,  etc.-  lie  makes  no  laws, 
they  are  made  for  him.  He  does  not  dream  or  speculate,  docs  not  philosophize.  He 
votes  \\ith  the  mass.  He  is  not  the  creative  type. 


266 


CAST    GOLD   AND    PORCELAIN    IX LAYS 


Fig.  213. 


Fig.    214. 


Fig.  215. 


A  CASE  OF  EXTENSIVE  EESTORATION. 

Fig.  213. — The  models  of  the  case  after  inlays  were  inserted.  As  may  be  seen, 
this  case  presents  considerable  malposition  of  a  number  of  teeth.  Note  the  occlusal 
surfaces,  the  distinct  cusps,  sulci,  marginal  ridges,  and  the  essential  bell  shape  of 
the  teeth  as  a  whole. 

Fig.  214. — Anterior  view  of  models  in  occlusion.  Note  the  overbite,  the  ten- 
dency to  tortion  of  the  right  lateral. 

Fi£.  215. — A  side  view  of  he  same  models  in  occlusion. 


EXTENSIVE    ItESTOItATlOX.S    OF    OCCLCSAL    J5ALANCK 


207 


Fig.  216. 


Fig.  217. 


Fig.  218. 


A  CASE  OF  EXTENSIVE  EESTORATION — CONT'D. 

Fig.  216. — A  lingual  view  of  the  models  in  occlusion.     Note  the  correct  inter- 
digitation  of  the  cusps. 

Figs.  217  and  218. — Views  of  the  same  models  in  occlusion,  but  cut  in  half  to 
show  the  inlays  more  clearly  in  outline  and  occlusion. 


268  CAST  GOLD  AND  PORCELAIN  INLAYS 

fore  away  from  the  approxlmal  space.  These  marginal  ridges 
lead  down  into  gutters,  which  in  turn  carry  the  escaping  food 
lingually  and  buccally,  so  that  in  the  normal  state  the  contact 
points  need  be  but  small  rounded  areas,  as  they  are,  to  prevent 
food  from  crowding  down  against  the  sensitive  and  easily  in- 
jured gingiva.  Thus  the  absolute  copying  of  Nature  in  the 
restoration  of  occlusal  surfaces  of  molars  and  bicuspids  not 
only  increases  the  masticatory  efficiency  by  supplying  cusps  and 
fossae,  but  protects  the  soft  parts  and  preserves  them  in  a  state 
of  health  because  of  the  marginal  ridges  and  sulci." 

SUMMARY  FOR  CHAPTER  XVIII 
Extensive  Restorations  of  Occlusal  Balance  "by  Means  of  Gold  Inlays 

1.  Name   the   two   causes  of   the   mutilation   of  the   occlusal   and   proximal 
surfaces. 

2.  What    are    the    preliminary    steps    before    beginning    a    case    of    extrusive 
restoration? 

3.  Explain  the  method  of  making  a  diagram  of  stress  from  the  model. 

4.  Explain  the  reasons  for  the  choice  of  the  first  tooth  to  be  operated  upon. 

5.  What  are  the  causes   of  attrition?     Name  a  predisposing  cause.     Name 
a  secondary  cause. 

6.  Describe  the  oral  conditions  in  a  case  of  marked  attrition. 

7.  How   would   you    determine    the    amount    of    gingivo-occlusal    restoration 
to  be  made? 

8.  What  steps  should  first  be  taken  in  the  actual  process  of  work  upon  the 
patient? 

Construction  of  the  Splint 

1.  Describe  the  making  of  the  splint,  giving  the  various  steps  on  the  model 
and  in  the  mouth. 

2.  How  would  you  determine  the  amount  of  opening  of  the  articulator  the 
case  requires? 

3.  What  is  the  reason  for  doubling  the  amount  of  the  necessary  gingivo- 
occlusal  restoration? 

4.  What   is   the   naso-mental   line    and   how   is   it   taken    into    consideration 
while  making  the  restoration? 

5.  Describe  the  construction  of  a  partial   splint. 

G.  With  the  teeth  in  normal  mesio-distal  relation,  how  is  the  amount  of 
building  up  determined? 

7.  Describe  the  changes  in  the  full  splint  while  the  process  of  reconstruction 
proceeds. 


(IIAPTKK  XIX 
COLD  IXLAYS  AXI)  TIIK  S1MCATHS  OR  POKCKLA1X 

For  cosmetic  reasons,  too  well  known  to  require  any  lengthy 
consideration,  the  cast  gold  inlay  is  in  itself  contraindicated 
in  anterior  teeth  and  even  first  bicuspids,  in  such  positions  as 
will  expose  any  considerable  portion  of  the  gold  to  the  vision 
of  the  person  with  whom  the  patient  conies  in  contact. 

Yet  in  a  great  many  cases  of  broken  or  worn  down  an- 
terior teeth,  the  cast  gold  inlay  is,  from  all  points  of  view  but 
the  one  mentioned,  the  very  best  restoration  possible;  in  fact, 
if  it  were  not  for  this  cosmetic  objection,  the  cast  gold  inlay 
would  prove  the  ideal  restoration  for  large  areas  in  anterior 
teeth,  and  it  must  follow  that  if  this  one  objection  can  be  over- 
come, we  shall,  in  the  cast  gold  inlay  have  as  perfect  a  re- 
creative process  for  anterior  teeth  as  it  has  proved  itself  to 
be  for  posterior  teeth. 

This  conclusion  led  me  to  a  series  of  tests  and  experiments 
which  were  not  restricted  to  my  own  practice  at  all,  but  were 
no  doubt  carried  on  by  a  great  number  of  men  who  realized  the 
advantage  of  the  casting  process  and  were  desirous  of  over- 
coming the  obstacles  to  its  use  in  the  anterior  teeth. 

Except  to  a  very  limited  extent,  I  have  no  means  of  de- 
termining just  how  extensive  these  experiments  of  the  other 
men  have  been,  or  how  successful  they  have  proved,  but  I  am 
in  a  position  to  state  that  in  my  own  practice,  the  cosmetic  ob- 
jection to  the  cast  gold  inlay  in  anterior  teeth  has  been  entirely 
overcome  by  the  use  of  porcelain,  or  the  silicates  in  conjunction 
with  the  inlay. 

Broadly  speaking,  all  but  the  part  exposed  to  view  is  re- 
placed with  a  gold  inlay,  and  a  portion  of  the  gold  inlay  is  so 
shaped  that,  with  the  remaining  part  of  the  tooth,  it  will  offer 
the  means  of  the  construction  of  a  simple  cavity,  which  may  be 
inlayed  with  porcelain  or  filled  with  a  good  silicate  cement. 

In  cases  of  marked  attrition,  where  the  crowns  of  anterior 

2C9 


270 


CAST    GOLD   AND    PORCELAIN    INLAYS 


Pig.  219. 


Fig.  220. 


Fiff.  223. 


Fig.  222. 


Fig.   224. 


Fiff.  225. 


GOLD    INLAYS    AND    THE    SILICATES    Oil    P011CELAIX  !_'  i  1 


GOLD  INLAYS  AND  PORCELAIN-  OR  THE  SILICATES. 

A  NUMBER  OF  VIEWS  OF  A  LOWER  CENTRAL  FK VCTURED  IN  A 
FALL. 

Fig.  219. — Lingual  view  of  cavity. 

Fig.  220. — Labial  view  of  cavity. 

Fig.  221. — Wax  inlay  before  providing  room  for  porcelain. 

Fig.  222. — Wax  inlay  in  position  carved  out  to  make  pro- 
vision for  porcelain  or  silicate. 

Fig.   223. — Wax   inlay  ready   to   be   mounted   on   sprue   wire 
for  investment  in  refractory  compound. 

Fig.  224. — Labial  view  of  completed  operation. 

Fig.  225. — Lingual  view  of  completed  operation. 

Stress   Index:      Downward,   inward   and    forward,   or   INTRA- 
ALVEOLAR   Unguo-mesiaUy. 


CAST    COLD    AX!)    I'OIU'KLA  1  X     INLAYS 


Fi-.   226. 


227. 


228. 


229. 


Fig.  2.32. 


INLAYS    AN!)    TIIK    SILICATKS    OH     POKCKI.A  I X 


A  XlMHKK  OK  VlKWS  OF  A  LOWEK  LATERAL  RESTORED  BY 
MKANS  OK  A  CAST  GOLD  INLAY  AND  SYNTHETIC  PORCELAIN. 

Fig.  226. — Labio-distnl  view  of  prepared  tooth.  Note  bevels 
at  im-isal,  distal,  ami  gingival  margins. 

Fii;-.  •2'27. — Lingno-iiK -iso-distal  view  of  prepared  tooth.  \<>te 
appearance  of  cavo-surface  and  the  continuity  of  linguo-incsial 
and  linguo-gingival  bevel. 

Figs.  228  and  229. — Lingual  and  cavo-surfacc  view  of  wax- 
inlay. 

Fig.  230. — Wax  inlay  in  position  on  the  tooth,  provision  made 
for  porcelain  or  synthetic  inlay. 

Figs.  ^31  and  232. — Linguo-inciso-distal  and  labio-distal 
views  of  the  finished  operation. 

Stress    Index:      Downward,    inward    and    forward,   or   INTRA- 

At.VKOLAR    tiiiflil»-ti:i  xioVll. 


274 


CAST    GOLD    AND    PORCELAIN    INLAYS 


Fiff.  233. 


Fie.  234. 


Fig.  235. 


Fie.  236. 


Fiir.   237. 


Fig.  238. 


iff.  239. 


GOLD    IXLAYS    AND    TIIK    SI  UCATF.S    OH    T'OHCKI.A  I X 


A   XTMBEK   (IF  VIEWS  OP  A  LOWER  LATERAL  INVOLVED  BY 

FlCAOTKK   AM)    I)K('AY  RESTORED  BY  THE  USE  OP  A   GOLD  INLAY  IN 

CoxjrxcTiox  WITH  SILICATE  CEMENT, — ROOT  FILLED. 

Fiu.   -'.',:',. — Labial   view  of  prepared   cavity. 

Fig.   234. — Lingual  vio\v  of  prepared   cavity. 

Fig.  235. — Wax  inlay,  lingual  view. 

Fig.  236. — Wax  inlay  in  position  on  the  tooth,  wax  carved 
out  to  provide  room  for  porcelain. 

Fig.   2.'!7. — Wax   inlay  ready   for  sprue  wire  for  investment. 

Fig.  238. — Labial  view  of  finished  operation. 

Fig.   2M9. — Linguo-niesial  view  of  finished  operation. 

This  proved  a  useful  and  lasting  operation  of  fine  appear- 
ance. 

stress  1  in  lex:  Downward,  inward,  forward,  or  IXTRAALVEO- 
I.AR  lingtut- 


CASt    GOLl)    AND    I'OKC'KI.AIX    JNI.AVS 

teeth  have  been  reduced  to  one-third,  or  oven  one-half  their 
length,  this  manner  of  restoration  has  been  so  valuable  that  it 
may  be  insisted  on  as  the  only  logical  one. 

Where  the  peridental  tissues,  and  by  this  are  meant  all 
the  tissues  in  the  region  of  the  peridental  membrane,  such  as  the 
gingiva,  the  alveolus,  the  suspension  ligament,  and  the  gingival 
and  subgingival  circumference  of  the  tooth,  are  free  from  any 
pathologic  invasion,  and  where  the  remaining  portion  of  the 
tooth  crown  is  free  from  caries,  the  excision  of  that  portion 
and  the  substitution  therefor  of  an  artificial  substance  is  a  need- 
less sacrifice  of  structure  and  may  be  avoided  by  resorting  to 
the  cast  gold  inlay  in  combination  with  the  silicates  or  por- 
celain. 

In  this  way  also  any  possibility  of  injuring  the  tissues  in 
the  peridental  region  is  avoided,  and  the  greater  longevity  of 
the  restored  tooth  assured. 

This  is  by  no  means  to  be  considered  as  an  argument 
against  porcelain  crowns  in  general,  or  as  a  condemnation  of 
the  porcelain  inlay  in  general;  each  has  its  place,  and  in  its 
place  it  can  not  be  successfully  supplanted  by  any  other  res- 
toration, but  there  can  be  no  question  about  its  having  been 
employed  in  cases  where  the  cast  gold  inlay,  in  combination 
with  one  of  the  silicates  or  porcelain  could  have  been  used  to 
much  greater  advantage. 

It  will  be  well  to  note  that  in  all  large  restorations  of  the 
anterior  teeth,  the  extirpation  of  the  pulp  is  usually  warranted, 
and  most  often  imperatively  indicated,  and  the  reason  for  this 
is  found  in  the  particular  formation  of  the  anterior  crowns. 
AVhen  a  large  portion  of  these  crowns  has  been  lost  through 
caries  or  attrition,  we  are  compelled  by  the  laws  of  physics 
to  invade  that  part  of  the  remaining  crown  which  is  greatest 
in  bulk  and  most  likely  to  resist  stress,  and  thus  offers  a  better 
seat  for  our  restoration  with  a  view  to  conservation  of  the 
tooth  as  a  whole,  and  we  shall  find  that  this  part  of  the  remain- 
ing crown  is  usually  occupied  by  the  pulp,  so  that  proper  root 
canal  work  becomes  an  important  factor,  and  is  the  first  sur- 
gical operation  to  be  considered  in  these  cases. 

The  root  canals  are  filled  from  the  apex  down  to  one-third 
of  the  length  of  the  canal,  the  remaining  portion  of  the  canal 


(iOLl)    INLAYS    AND    THE    S1L1CATKS    OK    POKCKLA 1 X  277 

reamed    out   to   receive    a    l."j   to   20   per   cent    iridio-platimim 
threa<led  post,  which  post  becomes  a  part  of  the  cast  gold  inlay. 
The  sizes  of  the  posts  for  the  various  teeth  may  be  stand- 
ardized as  follows: 

Upper  central  incisors  and  cuspids 12 

Upper  lateral  incisors    14 

Bicuspids  single  root   14 

Lower  central  and  lateral  incisors   16 

Lower  cuspids    13 

Lower   bicuspids    14 

All  these  posts  may  be  kept  on  hand  under  separate  covers 
in  two-inch  lengths.  The  receptacle  may  be  marked  on  the  out- 
side so  as  to  indicate  the  contents. 

The  following  simple  rules  must  be  remembered  in  con- 
nection with  the  use  of  posts: 

1.  The  post  is  to  aid  in  making  the  artificial  restoration 
and  the  remaining  portion  of  the  tooth  being  restored,  one  con- 
tinuous member,  the  cement  being  the  intermediary  agent. 

2.  The  longer  and  stouter  the  post  (within  the  limit)  the 
greater  the  area  of  contact  surface  and  the  greater  the  resist- 
ance to  stress. 

3.  The  length  of  the  post  should  be  at  least  %  the  length  of 
the  root.    Additional  contact  surface  is  obtained  by  threading 
the  post. 

In  accordance  with  all  the  laws  of  cavity  preparation,  and 
in  accordance  with  the  diagram  of  stress,  the  cavities  are  then 
prepared  and  the  wax  inlays  are  made,  which  wax  inlays  must 
engage  the  post.  This  is  accomplished  in  the  following  manner: 

A  cone  of  inlay  wax  softened  as  previously  directed,  is 
forced  into  the  cavity  and  chilled  under  pressure;  with  the 
proper  carvers  the  wax  is  then  trimmed  to  size  and  contour, 
the  right,  left,  and  straight  burnishers  assisting  in  the  opera- 
tion. A  hole  is  then  made  in  the  contoured  wax  inlay  lingually, 
this  hole  going  right  through  the  wax  and  leading  into  the 
root  canal.  The  hole  should  be  somewhat  smaller  in  size  than 
the  threaded  post.  The  latter  is  grasped  in  a  pair  of  pliers. 
slightly  heated  in  the  flame  of  the  alcohol  lamp  or  Bunsen 
burner,  and  forced  into  the  hole  in  the  wax  inlay,  and  put  into 


278 


CAST  GOLD  AXD  POBCBLA1N  INLAYS 


Fig.  240. 


Fig.  241. 


Fig.  242. 


Fi«?.  243. 


Fig.  244. 


Fig.  245. 


Fig.  246. 


GOLD    INLAYS    AND    TIIK    SILICATES    OR    PORCELAIN  -(!• 


A  NUMBER  OF  VIEWS  OK  A  LOWKK  LATERAL  FKACTUKED  IN  A 
FALL.  EXTIRPATED  PULP. 

Fig.  240. — Labial  view  of  cavity.     Note  bevel  and  step. 

Fig.  241. — Lingual  view  of  cavity.  Note  bevel  and  lingual 
lock  stop  with  depression  into  pulp  canal. 

I'iu.  242. — View  of  wax  inlay  before  providing  room  for  por- 
celain. 

Fig.    24:-!. — Wax    inlay    carved    out    to    provide    for    porcelain. 

Fi-.  2H. — Wax  inlay  ready  to  be  mounted  upon  sprue  wire 
for  investment. 

Fig.  245. — Mesio-labial  view  of  finished  operation. 

Fig.   246. — Mesio-lingual  view  of  finished  operation. 

Stress   Index:      Downward,   inward   and   forward,    or   IXTKA- 

ALVEOLAR    linti no- 


280 


CAST    GOLD   AND    PORCELAIN    INLAYS 


Fig.  248. 


Fig.   249. 


Fig.   250. 


Fig.  231. 


Fig.  2.32. 


Fiff.  253. 


GOLD    INLAYS    AXD    THE    SII.ICATKS    OR    1'OKCKLAIX  L.M 


SEVEX    VIEWS   OF   A   LOWER   CUSPID,   PRESENTING   ANOTHER 
TYPE  OP  RESTORATION-,  ALSO  A   COMBINATION   CAST  GOLD  INLAY 

AND    1'OKCKI.AI.V    INSERT. 

Stress    Index:      Downward,    inward,    forward,    hack   and   out- 
ward or  INTRAALVEOLAR  linguo-mesially  and  disto-labiaUy. 


282 


CAST  GOLD  AXD  PORCELAIN  INLAYS. 


Fig.  254. 


Fie.  255. 


Fig.  256. 


Fig.  257. 


Fig.  258. 


Fig.  259. 


Fig.  260. 


COLD    JXLAYS    AND    THE    .SILICATES    Oil    l'<  (KCKLAIN  283 


.  KX     YlKWS    OK    A     I5l«>KKX-I:0\VX     (Ysi'll)    RK.STOKK1)    "WITH     A 
('AST    (Joi.I)    iM.AY    AM)   A    !'()!;<  KI.AIX     IXSKKT.       T]IE    1 1-M'STKATIOXS 

AKK    SF.l.K  KX1M.AX  \T()KV. 

Stress    Index:      Dmvmvard,    inward,    forward,    back    and    out- 
ward or  IXTKAALVEOI.AI;  li Hi/no- nit xidtiy  and 


284 


CAST    GOLD   AND    PORCELAIN    INLAYS 


Fig.  261. 


Fig.  263. 


Fig.  264. 


Fig.  265. 


Fig.  266. 


Fig.  267. 


(iOl.D    IKLAYS    AND    T11K    SIUCATKS    (lit    1><  >IU 'KLA  I  X 


A  LEFT  UPPER  LATERAL  PRESENTING  A  MESIO-LABIO-LINGUO- 
J. \<ISAL  DEFICIENCY  RESTORED  TO  USE  AND  COSMETIC  ACCEPTABLE- 
NKSS  BY  A  CAST  GOLD  INLAY  AND  SYNTHETIC  PORCELAIN. 

Fig.  261. — A  mcsio-labial  view  of  prepared  cavity. 

Fig.  262. — A  linguo-mesial  view  of  prepared  cavity. 

Fig.  263. — Wax  inlay  in  position  on  the  tooth,  provision  made 
for  synthetic  insert. 

Fig.  264. — Lingual  view  of  wax  inlay.  Note  extension  to 
the  right. 

Fig.  265. — Cavo-surface  view  of  wax  inlay.  Note  definition 
of  steps. 

Figs.  266  and  267. — Mesio-labial  and  linguo-mesio-incisal 
views  of  finished  operation. 

Stress  Index:  Upward,  outward  and  backward  or  intraalvco- 
lar  LABIO-DISTALLY. 


286  OAST   <;<>U>   AND    PORCELAIN     [NIAYS 

the  root  canal.  The  wax  immediately  surrounding  the  post  will 
soften  sufficiently  to  attach  itself  to  the  threads  upon  it,  and 
after  a  cold  water  spray,  post  and  inlay  may  he  removed.  If 
there  he  any  deficiency  to  the  wax  lingual  I y,  the  quantity  lack- 
ing may  he  added  to  it.  Inlay  and  post  are  again  replaced  in 
and  onto  the  tooth,  the  carving  and  hurnishing  completed,  re- 
membering  that  all  burnishing  must  be  done  in  the  direction 
of  the  margins;  the  wax  is  rendered  smooth  with  the  cotton 
pellet  moistened  sparingly  with  oil  of  cajeput,  the  inlay  is 
carefully  but  firmly  held  in  position,  and  with  a  small  lance 
the  facial  part,  and  some  of  the  mesial  and  distal  surfaces  of 
it  are  removed,  leaving  a  box-like  simple  cavity,  presenting  a 
floor  and  four  walls,  the  gingival  wall  being  formed  by  the  in- 
cisal  surface  of  the  tooth.  The  wax  inlay  is  now  carefully  re- 
moved, and  the  sprue  wire  is  inserted  mesio-  or  disto-incisally. 
The  sprue  wire  is  placed  in  position  upon  the  crucible  former 
and  all  steps  necessary  for  proper  investment  and  drying  out 
of  the  mold,  the  cooling  down  of  the  same,  and  the  casting  of 
the  molten  metal  into  this  mold  are  gone  through  as  described 
before. 

Upon  completion  of  the  casting,  it  must  be  subjected  to 
its  various  cleansing  and  neutralizing  baths,  carefully  finished 
and  polished  with  the  various  stones  and  discs. 

If  we  are  to  replace  the  facial  portions  with  a  silicate,  then 
the  hoxlike  aperture  is  so  grooved  that  a  retentive  form  is 
obtained;  this  is  easily  accomplished  by  running  a  small  inverted 
cone  burr  along  the  incisal,  mesial,  and  distal  line  of  the  floor 
of  the  cavity  in  the  inlay. 

If  we  are  to  replace  the  facial  portions  with  a  porcelain 
inlay,  then  the  boxlike  aperture  in  the  cast  gold  inlay  must  be 
left  in  such  a  condition  that  no  undercuts  are  present,  so  as  to 
facilitate  the  taking  of  an  impression  of  the  facial  surface  of 
the  tooth  and  inlav  cavitv  when  the  gold  inlav  lias  been  cemented 

tf  V  */ 

to  place. 

AVhen  the  gold  inlay  has  been  completed,  the  rubber  dam 
is  applied  and  the  casting  is  cemented  to  place.  The  cement  is 
mixed  rather  thin  but  well  spatulated  and  some  of  it  is  pumped 
up  into  the  canal  by  means  of  a  jiffy  tube  when  the  casting- 
has  been  forced  into  position  by  the  fingers,  it  is  tapped  gently 


COLD    INLAYS    AND    TIIK    S1LICATKS    OK    1'ORCKLAIN  L.N7 

with  a  leather-covered  mallet,  driving  a  dull-pointed  instrument 
held  against  the  lingual  surface  in  a  Forward  and  upward  direc- 
tion. "When  the  cement  begins  to  set,  the  portion  which  lias 
been  Forced  into  the  Facial  boxlike  aperture,  is  removed  with 
an  excavator,  the  inlay  being  held  firmly  in  position  until  the 
cement  has  thoroughly  set.  The  cimple  cavity  now  presenting 
upon  the  facial  surface  of  the  partly  restored  tooth  may  be 
temporarily  tilled  with  thoroughly  softened  white  temporary 
stopping.  Xo  pressure  shall  he  exercised  upon  this  stopping, 
its  function  being  simply  to  occupy  >pace  to  prevent  the  ingress 
of  Food.  The  rubber  dam  may  now  be  removed,  and  further 
operation  postponed  For  another  day. 

At  the  next  sitting,  the  rubber  dam  is  again  applied,  the 
temporary  stopping  is  removed,  the  boxlike  cavity  is  thoroughly 
cleaned,  removing  every  trace  of  cement,  a  retentive  form  is 
produced  as  directed  and  the  cavity  filled  with  a  silicate  cement. 

The  color  of  the  gold  must  be  taken  in  consideration  when 
the  silicates  are  employed,  for  these  cements  being  markedly 
translucent,  will  allow  the  yellow  to  influence  their  shade  to  a 
great  extent,  so  much  in  fact,  that  if  a  blue  surface  be  required 
it  will  be  best  to  place  a  thin  piece  of  platinum  foil  upon  the 
floor  of  the  cavity  and  place  the  silicate  upon  that.  The  silicate 
must  be  kept  dry  for  a  period  of  twenty  minutes  to  one-half 
hour.  Some  parath'ne  wax  may  then  be  thrown  over  it  and  the 
rubber  dam  may  he  removed.  In  another  fifteen  minutes,  or  at 
a  subsequent  sitting,  the  filling  may  be  polished  with  fine  cuttle 
lish  discs,  charged  or  lubricated  with  paraffine  or  cocoa  butter; 
a  beautiful  restoration  will  be  the  result. 

It  is  essential  that  the  metal  of  which  the  gold  portion  of 
the  restoration  is  made  shall  not  yield  or  flow  under  the  maxi- 
mum of  masticatory  stress,  because  if  it  does  the  cavity  filled 
with  the  silicate  will  alter  its  geometric  lines  to  an  extent  great 
enough  to  fracture  the  silicate.  For  this  reason  these  inlays  are 
cast  in  a  special  alloy  to  be  considered  later  on. 

If  a  fused  porcelain  inlay  is  to  complete  the  facial  part  of 
this  anterior  restoration,  the  preparation  of  the  boxlike  cavity 
i>  somewhat  different,  its  linear  extent  being  greater  at  the 
orifice  than  at  the  floor,  so  that  each  surface  of  the  cavity  shall 
form  an  obtuse  angle  of  about  100°  with  the  floor. 


L'88 


CAST    GOLD    AND    PORCELAIN    IX LAYS 


Fig.    2C8. 


Fig.    2(59. 


Fin-.    270. 


Fig.   271. 


Fig.    273. 


Pi"-.    275. 


COLD    INLAYS    AND    TIIK    SILICATKS    Oil    PolICKLAI  X 


VIEWS  OK  A  RIGHT  UPPER  CENTRAL  PRESENTING  A  LARGE 
MESIO-LABIO-LlNGUO-IlNCISAL  DEFICIENCY,  RESTORED  TO  USE  AN1> 
COSMETIC  ACCEPTANLENESS  HY  A  CAST  GOLD  INLAY  AND  PORCELAIN 
INSERT. 

Fig.  268. — Mesio-labial  view  of  prepared  tooth.  Note  the 
obtuse  angle  at  median  line  of  the  gingival  seat  of  the  cavity  and 
the  acute  angle  between  the  mesio-labial  wall  and  mesio-gingival 
wall. 

Fig.  269. — Note  depth  and  definition  of  all  cavo-surface 
angles,  pulp  not  involved. 

Fig.  27d. — Mesio-linguo-gingival  view  of  prepared  tooth. 
Note  extension  of  cavity  linguo-gingivally,  the  acute  angle  created 
between  the  lingual  and  labial  plates.  This  acute  angle  extends 
from  the  incisal  end  of  the  cavity  to  its  extreme  linguo-gingival 
apex. 

Fig.  271. — A  cavo-surface  view  of  the  prepared  wax  inlay. 

Fig.  272. — A  lingual  view  of  the  prepared  wax  inlay. 

Fig.  273. — Wax  inlay  in  position  showing  boxlike,  or  simple, 
cavity  for  porcelain  insert. 

Figs.  274  and  275. — Mesio-labial  and  linguo-mesial  views  of 
the  finished  operation. 

Stress  Index:  Upward,  outward  and  backward  or  intraalveo- 
lar  LABIO-DISTALLY. 


290 


CAST  COLD  AND  PORCELAIN  INLAYS 


Fig.  276. 


Fig.  277. 


Fig.  278. 


Fig.  279. 


Fig.  281. 


Fig.  282. 


COLD     IX  LAVS    .'.XH    TIIK    Sll.lCATKS    OK     I'Ol!( 'Kl  .A  I  X 


VIKWS  OF  A  LEFT  UPPER  CEXTKAI.  I'KKSKXTIXG  A  MESIO  DISTO- 
LAHIO  IXCISAL  DEFICIKXCY.  RESTORED  TO  USE  AXD  COSMKTIC  Ac- 
CEPTABLF.XESS  BY  A  CAST  GOLD  IXLAY  AND  SYNTHETIC  PORCELAIX 
INSERT. 

Fig.  276. — Labial  view  of  the  prepared  tooth.  Note  the 
hovels  at  the  incisalj  mesial,  and  gingival  walls. 

Fig.  277. — Lingual  view  of  the  prepared  tooth.  Note  large 
bevel  linguo-gingivally,  and  central  keyed  groove  running  into 
root  canal  which  has  been  filled. 

Fig.  278. — Lingual  view  of  the  wax  inlay. 

Fig.  279. — Cavo-surface  view  and  view  of  prepared  labial 
surface  of  the  wax  inlay. 

Fig.  280. — Wax  inlay  in  position  upon  the  tooth,  wax  carved 
out  to  provide  for  porcelain  insert. 

Figs.  281  and  282. — Labial  and  lingual  views  of  the  finished 
operation. 

Stress  Index:     Upward,  outward  and  backward  or  int-raalvco- 

lur.    L\i:io  DISTAI.I.V. 


292 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Fig.  283. 


iff.  284. 


Fig.  285. 


Fig.  286. 


Fig.  287. 


Fig.  288. 


Fig.  289. 


GOLD    INLAYS    AND    THE    SILICATES    OR    PORCELAIN 


A  Xi  MI;KK  <>>•  VIEWS  OK  A  HK;UT  I'ri-KK  CENTRAL  PRESENTING 
AN  KRODED  AND  PITTED  LABIAL  SURFACE,  A  MKSIO-  AND  DISTO- 
PROXIMAL  CAVITY,  AND  A  LI.XGTAL  EXAMKL  SURFACE  WHICH  WAS 
PERFECT,  AS  WAS  THE  IXCISAL  EDGE. 

Fi^.  283. — Lingual  view  of  prepared  tooth.  Note  grooves 
liiiyuo  -distn  lly  and  linguo-mesially.  Note  linguo-mesial  and 
linguo-distal  acute  angles. 

Fig.  284. — Labial  view  of  prepared  tooth.  Note  taper  toward 
the  incisal  edge.  Note  shoulder  at  the  gingivo-labio-distal  ami 
mesial  portions  of  the  tooth  or  its  cervical  circumference. 

Figs.  285  and  286. — Labial  and  lingual  views  of  the  wax 
inlay. 

Fig.  287. — Wax  inlay  in  position  on  the  tooth  and  provision 
made  for  porcelain  insert. 

Figs.  288  and  289. — Linguo-incisal  and  labial  view  of  fin- 
ished operation. 

Stress  Index:  Upward,  outward  and  backward,  or  intraalveo- 
lar  LABIO-DISTALLY. 

The  question  will  come  up  as  to  why  a  complete  porcelain 
jacket  crown  or  a  cast  base  porcelain  crown  was  not  made  for 
this  tooth,  and  this  must  be  answered.  . 

I  believe  that  all  jacket  crowns  are  injurious  in  so  far  as 
tJicif  completely  cover  something  that  Nature  meant  should  be 
exposed  to  aerobic  influence. 

Gold  is  more  objectionable  than  porcelain  because  it  irritates 
tin  lninno,\y  of  the  visual  field;  bnt  a  gold  jacket  crown  docs  no 
mo-re  than  cover  up  the  organ  or  tooth. 

Cases  have  come  under  my  observation  and  treatment  where 
the  mere  removal  of  gold  and  porcelain  jacket  crowns  and  some- 
times the  polishing  of  the  remaining  portion  of  the  uncovered 
tooth  or  teeth,  more  often  the  excision  of  the  crowns  and  substitu- 
tion of  it  by  a  cast  base  crown,  have  done  away  with  such  func- 
tional dystrophies  of  the  central  nervous  system  as  loss  of  pati- 
ence, impaired  vision,  loss  of  memory,  and  general  irritability 
to  surroundings  which  before  seemed  perfectly  congenial. 


294  CAST'  COLD  AND  PORCELAIN  INLAYS 


1  was  gradually   forced  to  formulate  the  following  laws  for 
myself  as  a  guide  in  practice. 

1.  That  part  of  the  tooth  which,  covered  with  enamel,  rises 
out  of  the  alveolar  socket  into  space  is  intended  to  live  in,  and 
be   subjected   to,   extra-aerobic   currents,   and   must   never   be   al- 
together deprived  of  this  apparently   m  c<  xxtiry  r<  lationship. 

2.  One  is  justified  in  excising  a  badly  broken-down  tooth  and 
I-"  r i  ring  the  roots  of  the  tooth  with   a  cast  base  crown  because 
the  root  is  not  in  normal  cases  exposed  to  extra-aerobic  inflit<m-<. 

3.  A  jacket  crown  is  harmful  and  unsafe  because  it  robs  all 
that  part  off  the  tooth  which  was  left  abovG  the  gum  of  its  bath 
in  the  sea  of  air  which  surrounded  it. 

4.  An  inlay   or  type   of  restoration   here   shown   enables  the 
tooth  to  keep  up  its  relationship  with  the  air  by  virtue  of  the 
remaining  portion  of  enamel  upon  the  lingual  surface. 

5.  It  will  get  the  quantity  of  air  which  it  needs  through  the 
medium  of  this  small  part  of  itself  by  simply  taking  up  the  air 
more  rapidly,   even  as  a   man  who   has  been   walking  briskly   or 
running  gets  his  quota  of  oxygen  by  increasing  the  rate  of  his 
inspirations  and  expirations. 

6.  In  inserting  a  filling  or  inlay  into  a  tooth,  it  is  safer  to 
cut  through  the  enamel  and  inlay  the  dentine  than  it  is  to  partly 
cut  through  the  enamel  and  seal  this  partly  cut  enamel  surface. 

7.  The  enamel  of  the  teeth  comes  from  the  ectodermic  layer 
and  is  formed  by  the  evolution  of  this  layer. 

The  central  nervous  system  conies  from  the  ectodermic  layer 
and  is  formed  by  the  involution  of  this  layer. 

8.  Constant    trophic    irritation    of    any   part    of   the    enamel 
of  a  tooth  will  cause  a  disturbance  of  the  central  nervous  system. 

9.  Depriving  a  tooth  which  is  left  standing  in  the  oral  cavity 
of  its  required  aerobic  bath  is  a  constant  trophic  irritation. 

10.  This  is  the  reason  that  clasps  are  dangerous  and  should 
hardly  ever  or  never  be  used   unless  the  part  of  the  tooth   with 
which  it  comes  in  contact  has  been  inlayed  to  the  full  depth  of 
its  enamel  wall. 

11.  Nature  knows  best,  let  the  tooth  breathe. 


GOLD    INLAYS    AND    THK    SI  LICATKS    oil    I'olK 'KI.A1  N  -!!),") 

A  matrix  may  then  be  burnished  into  this  cavity.  aii<l  the 
porcelain  fused  into  this  matrix,  or  an  impression  is  taken  of 
this  simple  cavity,  an  amalgam  die  is  made  as  described  before, 
and  the  die  is  mounted  in  a  small  swaging  cup  so  that  it  may  be 
placed  in  a  small  Ajax  swage,  and  the  matrix  swaged  into  and 
onto  the  die.  J>efore  any  attempt  is  made  to  remove  the  matrix 
from  the  cavity,  direct  or  from  the  die,  it  is  best  to  fill  the  matrix 
with  a  bit  of  wax  and  to  bring  this  wax  over  the  margins  of  the 
cavity  to  supply  an  ordinarily  indestructible  or  unchangeable 
rigidity  to  the  matrix. 

The  matrix,  carrying  the  wax,  is  then  invested  in  a  paste 
of  silex  and  water,  or  ground  asbestos  and  water,  and  care  is 
taken  to  so  tack  the  platinum  around  the  margins,  that  it  will 
prove  difficult  for  it  to  warp;  with  this  end  in  view  the  margins 
may  be  curled  downward  so  that  they  be  securely  held  against 
displacement. 

The  thinner  the  platinum  foil  used  for  the  matrix,  and  the 
greater  the  care  given  to  the  swaging  of  it,  the  more  perfect  a  fit 
will  be  obtained.  For  this  reason  a  foil  of  l/'soo  of  an  inch  in 
thickness  is  used,  and  this  is  carefully  adapted  to  the  floor  of 
the  cavity  with  a  pellet  of  cotton,  held  in  the  foil  carriers,  the 
ends  of  which  should  be  rounded.  The  size  of  the  pellet  of 
cotton  is  gradually  increased,  until  it  is  large  enough  to  force 
the  platinum  foil  along  the  floor  of  the  cavity  towards  the  walls 
anil  margins. 

The  writer  considers  the  safety  depth  or  retention  depth 
for  these  cavities  to  be  no  less  than  1  mm.  and  they  should  be 
no  less  than  I1-  to  2  mm.  in  depth;  any  depth  greater  than  the 
latter  uselessly  endangers  the  integrity  of  the  foil. 

After  the  more  or  less  complete  adaptation  of  this  foil,  the 
floor  and  walls  of  the  cavity  in  the  die,  the  burnishers  are  used 
to  marginally  outline  the  cavity,  the  margin  of  necessity  pre- 
senting a  smooth  unbuckled  appearance. 

The  swaging  cup  holding  the  die  and  the  matrix,  may  then 
be  placed  in  the  loose  end  of  the  swager,  a  rubber  dam  disc  is 
placed  over  the  matrix,  and  the  piston  of  the  swager  is  struck 
two  or  three  smart  blows  with  a  large  horn  mallet. 

Upon  examination  the  matrix  will  be  found  to  have  become 
perfectly  adapted  to  the  cavity  in  the  die.  As  said  before,  this 


296 


CAST  GOLD  AXD  PORCELAIN  INLAYS 


Fig.  290. 


Fig.  291. 


Fig.  292. 


Fig.  293. 


Fig.  294. 


Fig.  296. 


GOLD    INLAYS    AND    THE    SILICATES    OR    POKCKI.A  I  X  '2(,)~ 


SEVEX  VIEWS  or  ANOTHER  TYPE  OF  RESTORATION  IN  AN  UPPER 
ci  SIMM.  THE  FORMATION*  OF  THE  CAVITY,  THE  ACUTE  AND  OBTUSE 
ANGLES  ARE  CLEARLY  TO  BE  SEEN  IN  FIGS.  290  AND  291. 

Figs.  292,  293,  and  294  arc  views  of  the  inlay  in  and  out  of 
the  tooth. 

Figs.  295   and   296  are  views  of  the   finished  operation. 

Stress  Index :  Upward,  out  and  forward  and  out  and  back- 
ward  or  intraah'colar,  LABIO-MESIALLY  and  LABIO  DISTALLY. 


298 


CAST    GOLD    AND    I.'OIl('KLAI  X    INLAYS 


Fig.  207, 


Fig.  299. 


Fig.  300 


Fig.   302. 


(JOLD    INLAYS    AND    TIIK    SILK'ATKS    OK     !'OU< 'KLAI  N  L_'|)|) 


SKVKN  YIKWS  UK  A  RIGHT  UPPER  GYspiD  PRKSKXTIM;  A  I'RK- 
IIKNSO  LABio-Li.\(;ro-.\lK.siAL  DEFICIKNCY. 

Note  carefully  in  Figs.  297  and  298  the  formation  of  the 
cavity  and  the  grooves  for  retention,  and  in  Figs.  299,  300,  and 
301,  views  of  the  wax  inlay  in  and  out  of  the  tooth.  Figs.  302 

and  .'!()3  are  views  of  the  finished  operat'on. 

Stress  Index:  Upward,  out  and  forward  and  out  and  back- 
ward or  intfdcln  »!nr,  LABIO-MESIALLY  and  LABlO-DlSTALLY. 


300  CAST  GOLD  AND  PORCELAIN  INLAYS 

matrix  must  now  be  filled  with  some  wax,  and  tlie  wax  must 
overlap  the  margins  of  it,  so  that  upon  removal  of  the  matrix 
from  the  die,  no  distortion  is  possible. 

Upon  investment  of  the  matrix  as  described,  and  upon  dry- 
ing out  of  this  investment,  we  shall  be  ready  to  burn  out  the 
wax  and  to  biscuit  and  fuse  our  porcelain. 

This  one  problem  has  been  vexing  and  irritating  the  dental 
profession  ever  since  porcelain  first  made  its  appearance  as  a 
filling  material,  and  unquestionably  the  inability  of  the  general 
man  to  solve  the  riddle  is  responsible  for  the  fact  that  porcelain 
is  so  sparingly  used  for  inlay  work,  even  when  strongly  in- 
dicated. 

These  men  who  have  been  teaching  porcelain  inlay  work 
and  porcelain  work  in  general,  the  men  wrho  have  written  about 
its  manipulation,  its  advantages,  the  indications  for  its  use,  and 
the  contraindications,  never  troubled  themselves  or  the  student 
much  about  the  color  problem,  and  left  that  to  the  commercial 
house  to  solve,  an  error  fraught  with  dire  consequences  to  the 
immediate  future  of  ceramics  in  dentistry. 

The  reason  for  all  this  is  to  be  found  in  the  condition  that 
men  have  been  teaching  this  art  without  comprehending  just 
how  important  a  part  the  color  problem  plays  in  it,  and  the 
men  who  have  been  learning  the  art  failed  in  turn  to  realize 
that  to  their  ignorance  of  the  relation  existing  between  different 
colors  and  of  the  results  to  be  obtained  when  these  relations  are 
made  use  of  in  various  proportions  is  due  their  lack  of  success 
in  porcelain  restorations. 

No  matter  how  charitably  we  may  wish  to  look  upon  it,  we 
are  forced  to  the  conclusion  that  there  has  been  woeful  aimless- 
ness  about  this  branch  of  our  work;  we  have  tried  for  years 
to  do  something  without  being  in  possession  of  the  necessary 
groundwork  knowledge  of  that  which  in  a  great  measure  would 
have  proved  the  key  to  our  success. 

Eealizing  that  other  phases  of  the  ceramics  as  applied  to 
dentistry  have  been  sufficiently  enough  elaborated  upon  by  other 
investigators  and  teachers  to  be  quite  clearly  understood  by 
those  who  read  this  volume,  I  will  here  confine  myself  to  a  more 
or  less  fragmentary,  but  nevertheless  pointed  and  easily  grasped, 
explanation  of  this  phase  of  the  art,  which  I  feel  has  been  ucg- 


(JOLI)    INLAYS    AND    TIIH    S1UCATKS    OK    1'OIK  T.I  .A  I  X 

lected  by  investigators,  and  is  little,  if  at  all,  understood  by  the 
general  practitioner. 

SUMMARY  TOR  CHAPTER  XIX 
Gold  Inlays  and  the  Silicates  or  Porcelain 

1.  In  what  cases  is  the  restoration  of  incisal  edges  by  inlays  in  conjunction 
^sith  porcelain  preferable  to  the  excision  of  the  tooth? 

2.  Describe  the  preparation  of  a  root  canal  to  receive  a  post  and  give  the 
gauges  of  the  posts  used  in  the  various  teeth. 

3.  Give  the  rules  in  the  use  of  posts. 

4.  Describe  the  taking  of  an  impression  for  a  silicate   insert. 

5.  Describe  the  cementation  of  the  inlay,  the  choice  of  color  and  the  mak- 
ing the  silicate  filling. 

6.  How  would  you  prevent   the  fracture  of  the  silicate  insert  in  a   tooth 
subject  to  material   stress? 

7.  Describe  the  making  of  the  porcelain  insert. 


CHAPTER  XX 
THE  PHENOMENA  OF  LIGHT  AND  COLOR 

The  general  doctrine  of  that  form  of  radiant  energy  known 
as  light  is  now  only  a  part  of  the  general  theory  of  radiation, 
which  comprises  radiant  heat  and  actinic  and  electric  radiation; 
but  since  the  battle  as  to  the  nature  of  radiation  in  general  was 
first  waged  around  light  itself,  it  is  convenient  to  consider  light 
as  representing  all  the  forms  of  radiation. 

By  elementary  observation  it  is  found  that  light  travels  (in 
a  uniform  medium)  in  straight  lines  in  all  directions;  that  is, 
when  proceeding  from  a  point  or  a  very  small  source  covers 
areas  which  vary  as  the  squares  of  the  distance,  and  that  shad- 
ows obey  a  similar  law. 

Light  is  seen  some  time  before  the  corresponding  sound  is 
heard.  The  most  common  illustration  of  this  may  be  found 
during  any  thunder  storm,  the  lightning  being  visible  long  be- 
fore the  sound  of  thunder  reaches  the  ear. 

All  this  points  to  a  rapid  propagation  of  something  in 
straight  lines.  Is  it  matter,  motion,  or  condition? 

The  simplest  explanation  was  that  luminous  bodies  emitted 
something  material  whose  impact  affected  the  sensitive  eye; 
that  the  reflection  of  light  at  surfaces  was  due  to  elastic  rebound 
of  these  quick  traveling  materials.  These  prenomena  might 
be  equally  as  well  explained  by  waves  traveling  and  being  re- 
flected. 

Sir  Isaac  Newton  could  not  reconcile  himself  to  the  opinion 
of  waves  traveling  past  obstacles  and  not  spreading  behind 
them.  This  seeming  anomaly  led  him  to  adopt  and  develop  the 
corpusecular  or  emission  theory  of  light.  According  to  this,  all 
luminous  bodies  emit  with  equal  velocities  a  number  of  elastic 
corpuscles  that  travel  in  straight  lines,  are  reflected,  and  are 
refracted  at  the  surface  separating  two  media.  Rays  of  white 
light  when  refracted  are  generally  dispersed,  owing  to  the  con- 
stituents having  different  refractive  indices. 

302 


PHENOMENA    ()!•     I.ICIIT    AND    COI.OK  .'!().'! 

For  the  ordinary  phenomena  of  reflection  and  refraction  the 
('mission  theory  was  sufficiently  satisfactory,  Imt  in  order  to 
explain  the  phenomena  of  refraction  and  polarization,  the  theory 
became  overloaded  with  a  mass  of  hypotheses.  Newton  main- 
tained this  theory  to  the  time  of  Sir  David  IJrewster. 

The  wave  theory  of  light  was  surest ed  by  (Irimaldi,  Hook 
and  others,  used  by  Huygens  (1678)  to  explain  double  refrac- 
tion; it  had  few  sponsors  when  revived  by  Young  in  the  begin- 
ning of  the  nineteenth  century.  It  was  more  fully  recognized 
and  its  phenomena  made  clear  by  Tresuel  in  181."),  and  on  and 
until  it  finally  and  definitely  supplanted  the  emission  theory. 

According  to  this  theory,  light  consists  of  vibrations  in  an 
all  pervading  elastic  ether,  and  these  vibrations  are  in  direc- 
tions at  right  angles  to  the  directions  of  propagation;  and  "ra\> 
of  light"  are  mere  lines  showing  the  direction  of  propagation 
of  (and  in  isotropic  media  at  right  angles  to)  the  corresponding 
portions  of  the  Avave  front. 

The  wave  theory  readily  explains  refraction;  in  refraction 
it  assumes  that  the  AvaATes  travel  less  rapidly  in  the  denser 
medium  (which  is  found  to  be  true)  and  it  explains  the  accom- 
panying reflected  AvaA'e;  it  explains  double  refraction,  polariza- 
tion, absorption  of  light,  interference,  color  and  complementary 
colors,  diffraction,  etc.  All  these  phenomena  are  explicable  as 
phenomena  of  rhythmic  disturbance  of  some  kind  and  the 
wave  theory  really  goes  no  further  than  to  state  this.  The 
rhythmic  disturbance  may  be  one  of  position,  wave  motion,  of 
stress,  of  electrical  condition,  possibly  a  twist  in  the  ether. 
Clerk  Maxwell  holds  that  every  portion  of  the  ether  in  the  path 
of  a  beam  of  light  is  subject  to  rapidly  alternating  stresses 
transverse  to  the  ray,  and  is,  therefore,  in  a  rapidly  alternating 
electric  and  also  in  a  rapidly  alternating  magnetic  condition, 
and  the  curious  relation  now  known  to  exist  between  beams  of 
light  and  the  field  of  force  of  a  magnet  lends  support  to  this 
theory.  The  experiments  of  Hertz  tend  to  prove  that  all  the 
phenomena  of  light,  radiant  heat  and  actinic  radiation  are  re- 
duced to  phenomena  of  electro-magnetic  radiation  between  cer- 
tain limits  of  wave  length. 

Although  these  facts  have  no  important  or  direct  bear- 
ing on  the  subject  involved,  it  may  l>e  of  interest  to  note  that 


CAST  GOLD  AND  PORCELAIN  INLAYS 

the  velocity  of  light  was  first  found  by  Himiiis,  the  eclipses  of 
Jupiter's  satellites  when  they  were  at  the  greatest  and  the  least 
distance  from  the  earth;  but  it  can  be  measured  in  the  labora- 
tory by  a  purely  experimental  method.  The  mean  of  all  ob- 
servations is  that  light  of  all  wave  lengths,  travels  in  vacuo 
with  a  velocity  of  30,057,400,000  centimeters,  or  186,772  meters, 
per  second;  in  air  with  a  velocity  less  than  this  in  the  ratio 
of  10,000  to  10,003.  The  length  of  waves  can  be  ascertained 
from  measurement  at  adequate  distance  to  the  fringes  produced 
by  interference,  or  by  the  use  of  diffraction  gratings  ruled  with 
a  known  large  number  of  lines  to  the  inch  (40,000  or  more). 

The  wave  lengths  of  radiant  heat,  light  and  actinic  radia- 
tions range  from  1/660  cm.,  or  1/16,500  in.  (the  longest  invisible 
heat  rays  lengthwise)  to  1/1,300,000  cm.,  or  1/62,500,000  m. 
(visible  actinic  rays;  the  visible  limits  are  1/13,042  and  1/25,186 
cm.  The  frequency  or  number  of  waves  per  second  accordingly 
range  from  20  million  per  second,  the  extreme  visible  limits 
being  392  to  757  million  of  millions  per  second. 

In  optical  instruments  a  pencil  of  rays  sometimes  deviates 
from  the  point  through  which  every  component  ray  of  the  pen- 
cil should  pass.  Spherical  aberration  results  from  the  spherictiy 
of  length  surface  or  of  the  mirror  used  to  produce  the  image 
of  the  object.  Chromatic  aberration  is  due  to  the  different  re- 
frangibilities  of  the  components  of  white  light.  Ref.:  Tait, 
Glazbrook,  Stokes,  Preston  and  Wood  on  Light  and  Optics. 

REFLECTION  AND  REFRACTION  AND  ABSORPTION 

A  surface  on  which  a  beam  of  light  falls  may  be  either 
rough  or  smooth.  If  it  be  rough,  the  greater  part  of  the  inci- 
dent light  is  irregularly  scattered  by  the  innumerable  surface 
facets,  to  be  reflected  or  dispersed  in  all  directions;  if  it  be 
smooth,  a  proportion  (never  the  whole)  of  the  incident  light 
is  regularly  reflected  or  turned  back  in  denfiite  paths.  A  smooth 
dustless  mirror  is  not  visible  to  the  eye  outside  the  track  of  rays 
reflected  from  it.  If  that  polished  surface  be  that  of  a  trans- 
parent substance  (like  glass)  optically  denser  than  the  medium 
conveying  the  light  of  it,  comparatively  little  light  is  reflected : 
The  more  oblique  the  incidence,  the  smoother  the  polish,  and 


PIIKXO.MKXA    or    I.ICHT    AXI>    COLOR 

the  greater  tlie  difference  between  the  optical  density  of  the 
glass  and  that  of  the  medium  in  which  it  is  immersed,  the 
greater  will  be  the  proportion  reflected.  Less  light,  will  be  re- 
flected from  glass  under  water  than  will  be  reflected  from  tin- 
same  glass  in  air. 

If  the  light  travel  in  a  denser  medium  and  strike  the  bound- 
ing surface  between  it  and  the  rarer  medium,  as  where  light  is 
ascending  through  water  and  strikes  its  upper  free  surface,  it 
will,  if  its  obliquity  of  incidence  exceed  a  certain  limit,  be  al- 
most totally  reflected,  the  small  loss  that  ensues  arising  wholly 
from  absorption  while  no  light  is  transmitted  into  the  air  above. 

On  reflect  ion  from  polished  surfaces  we  have  so  far  as 
regards  the  directions  of  the  reflected  rays  the  following  laws: 

1.  The  incident  ray,  the  normal  (i.  e.,  a  line  drawn  per- 
pendicularly) to  the  surface  at  the  point  of  incidence,  and  the 
reflected  "ray"  all  lie  in  one  plane,  the  plane  of  ".incidence." 

'2.  The  angle  of  incidence  (the  angle  which  the  incident  ray 
makes  with  the  normal  to  the  reflecting  surfaces)  is  equal  to  the 
angle  of  reflection  (the  corresponding  angle  between  the  normal 
and  the  reflected  "ray"). 

These  laws  apply  equally  to  ether  waves  of  all  lengths,  and 
therefore  to  light  of  all  colors,  no  matter  what  the  shape  of  the 
surface  may  be. 

1.  Uays  which  are  parallel  to  one  another  before  striking  a 
plain  reflecting  surface  are  parallel  after  reflection. 

2.  If  light  diverging  from  or  converging  towards  a  point 
be  reflected  from  a  plain  mirror,  it  will  appear  after  reflection 
to  diverge  from,  or  converge  towards  a  point  situated  on  the 
opposite  side  of  the  mirror  and  at  an  equal  distance  from  it. 

In  curved  reflecting  surfaces  we  must  trace  out  the  mode 
of  reflection  of  incident  rays  from  each  element  or  little  bit  of 
the  reflecting  surfaces;  and  through  geometric  workings,  we 
arrive  at  the  following  propositions: 

1.  Parallel  rays  traveling  parallel  to  the  axis  of  a  con- 
cave paraboloid  mirror  are  made  to  converge  so  as  to  actually 
pass  accurately  through,  i.  e.,  the  geometric  forms  of  the  para- 
boloid; and,  of  course,  if  the  course  of  light  be  at  the  focus,  t he- 
rays  reflected  from  the  mirror  emerge  parallel  to  one  another. 


306  CAST  GOLD  AND  POKCELAIX  IXLAYS 

In  spherical  reflections  there  is  no  accurate  focus  except  for 
rays  proceeding  from  the  center  and  returning  to  it. 

When  these  reflections  are  small  as  compared  to  the  dis- 
tance of  the  center  of  curvature,  they  act  approximately  like 
parabolic  reflectors  for  parallel  rays. 

Rays  parallel  to  the  axis,  that  is,  rays  from  a  distant  source 
of  light,  are  reflected  so  as  to  pass  through  the  principal  focus. 
Concave  mirrors  act  like  concave  lenses. 

Refraction 

When  a  beam  of  light,  traveling  in  a  transparent  medium, 
impinges  obliquely  upon  the  surface  of  another  transparent 
medium,  a  part  of  the  light  is  reflected,  and  a  part  of  it  enters 
the  second  medium,  but  in  so  doing  it  is  refracted  or  bent  out 
of  its  former  course.  The  incident,  reflected,  and  refracted  rays 
lie  in  one  plane. 

Snell,  in  1621,  elucidated  the  following  law  of  refraction. 
''The  sine  of  the  angle  of  incidence  bears  to  the  sine  of  the 
angle  of  refraction  a  ratio  which  remains  constant  for  any  two 
media,  whatever  be  the  angle  of  incidence. ' ' 

This  law  of  refraction  is  an  immediate  deduction  from  the 
properties  of  wave  motion;  if  we  assume  that  the  speed  of  propa- 
gation of  light  is  different  in  the  different  media.  When  a  wave 
passes  over  the  surface  of  water,  the  direction  of  propagation 
is  perpendicular  to  the  crest  or  through  the  wave  motion.  In 
like  manner  we  imagine  the  ray  of  light  to  be  perpendicular 
to  what  is  called  the  wave  front,  which  propagates  itself  through 
the  medium  with  the  speed  of  light.  So  long  as  the  light  is 
confined  to  one  and  the  same  medium,  any  wave  front  on  which 
we  fix  our  attention  will  travel  forward  so  as  to  ever  be  parallel 
to  its  original  position. 

In  Fig.  304  let  AA'A"  represent  one  of  a  pencil  of  rays  im- 
pinging obliquely  on  the  surface  B.  The  wave  front  may  be 
represented  by  a  line  through  A  perpendicular  to  the  direction 
of  propagation.  At  the  end  of  a  certain  time  the  wave  front  is 
at  A' ;  after  another  interval  of  equal  duration  it  is  at  A".  Dur- 
ing the  next  equal  interval  of  time,  a  gradually  diminishing 
breadth  of  wave  is  traveling  the  original  medium  with  the 
original  speed;  while  a  steadily  widening  portion  of  the  wave 


:;o7 

front  is  entering  the  second  medium.  If  we  suppose  the  speed 
of  propagation  of  the  disturbance  to  he  less  in  the  second 
medium,  it  is  clem-  {hat  the  end  A.  which  has  been  traveling  in 
the  second  medium,  while  the  end  A"  has  still  been  in  the  first 
medium,  must  have  traveled  over  a  shorter  distance.  The  wave 
front  through  .1  will  then  proceed  to  move  in  the  second  me- 
dium, so  as  always  to  remain  parallel  to  its  original  direction 
in  this  medium,  hence  the  refracted  wave  front  moves  on  at  a 
less  inclination  with  the  interface  separating  the  media  than 
that  with  which  the  original  wave  front  impinged  upon  the  in- 
terface. Again  the  distance  of  A"  from  the  surface  H,  as  meas- 
ured along  the  ray  will  be  greater  than  the  distance  from  the 


Fig.  304. 


same  surface  as  measured  along  the  ray,  in  the  ratio  of  the 
speeds  of  propagation  in  the  two  media. 

This  ratio  is  the  ratio  of  the  sines  of  the  angles  of  incidence 
and  refraction  as  given  in  Snell's  law,  and  is  called  the  refrac- 
tive index  of  the  second  medium  as  compared  with  the  first. 
Thus  physically,  the  refractive  index  of  any  transparent  medium 
is  the  ratio  of  the  speed  of  propagation  of  light  in  empty  ether 
to  its  speed  in  the  medium,  the  medium  in  which  light  travels 
more  slowly,  is  said  to  have  the  greater  optical  density. 

If  we  regard  A  A'  to  be  the  original  ray  traveling  in  the 
denser  medium  being  refracted  as  A" A' A  in  the  less  dense 
medium,  we  just  reverse  the  direction  of  the  rays  without  any 
change  in  the  relation  of  the  angles,  except  that  the  refractory 


308  (AST    COLD    AND    POIH'KLAIX    IX  l.AVS 

ray  is  now  bent  away  from  the  normal  or  perpendicular  to  the 
surface.  Imagine  the  incident  ray  in  the  denser  medium  to  he- 
come  more  and  more  oblique  to  the  interface,  the  refracted  ray 
will  tend  more  and  more  to  parallelism  with  the  interface,  and 
finally  for  a  definite  incidence  will  pass  along  it. 

For  higher  incidence  than  this  critical  angle,  no  refracted 
ray  will  pass  out;  the  light  will  be  wholly  reflected  within  the 
denser  medium  leaving  out  of  account  what  is  absorbed  at  the 
interface.  This  angle  is  the  angle  of  total  reflection  or  the 
critical  angle. 

Absorption 

If  a  ray  of  sunlight  be  allowed  to  fall  upon  a  glass  prism, 
it  will  be  found,  on  emerging,  to  be  split  up  into  a  color  band, 
which  is  called  the  solar  spectrum.  Conversely,  these  colors, 
when  combined  produce  ordinary  white  light;  most  substances 
when  exposed  to  sunlight  have  the  power  of  reflecting  one  or 
more  of  these  colors,  and  of  absorbing  the  rest.  Thus,  if  a 
ray  of  sunlight  falls  on  a  patch  of  grass,  the  grass  absorbs  all 
the  colors  of  the  white  light  except  the  green,  which  it  reflects. 
These  reflected  rays  meet  the  eye  and  convey  to  it  a  sensation 
of  greenness;  and  hence  the  grass  appears  as  a  substance  green 
in  color.  Similarly  a  poppy  is  red,  because  it  absorbs  all  the 
rays  except  the  red,  which  it  reflects,  and  thus  assumes  a  red 
hue.  In  the  case  of  a  white  flower,  none  of  the  colors  of  the 
spectrum  are  absorbed;  all  are  reflected.  On  the  other  hand, 
a  black  cloth  absorbs  all  of  the  rays  and  reflects  none  of  them, 
and  so  appears  black.  A  red  liquid  or  glass  transmits  only  the 
rays  at  the  red  end  of  the  spectrum  and  absorbs  the  others,  and 
so  with  the  other  colors.  A  cobalt  blue  glass  transmits  only 
blue  rays,  and  the  extreme  red  rays,  while  a  glass  colored  red 
with  copper  oxide  absorbs  the  blue  and  transmits  the  red.  If 
then  these  two  glasses  be  placed  one  in  front  of  the  other,  and 
ordinary  white  light  be  allowed  to  fall  upon  them,  the  combina- 
tion permits  only  the  extreme  red  rays  to  reach  the  eye,  thus 
producing  a  very  pure  deep  red.  This  method  of  combining 
different  absorbing  media  is  employed  to  obtain  definite  colors 
in  purity;  thus  white  light  passing  through  these  cells,  one  con- 
taining aniline  blue,  one  chromate  of  potash,  and  one  copper  or 


I'liKNOMKXA    OF    LIGHT   AX1)    COLOR  309 

sulphate,   is   successively   robbed   of   its    blue,    yellow,    and    red 
rays,  and  the  emergent  light  is  pure  green. 

The  absorption  of  light  by  gases  follows  a  different  law. 
The  white  light  falls  on  a  cool  gas,  the  gas  absorbs  only  those 
rays  which  it  would  itself  emit  if  incandescent,  and  leaves  dark 
lines  in  their  places  in  the  spectrum  of  the  light.  The  vapor  of 
sodium,  which  is  yellow,  when  incandescent  absorbs  yellow  rays, 
when  cool.  On  the  other  hand,  if  the  gas  be  incandescent,  ab- 
sorption still  takes  place,  but  the  light  of  the  gas  is  substituted 
in  the  spectrum  for  the  light  absorbed,  producing  a  bright 
yellow  band  there. 

The  color  band,  called  the  solar  spectrum,  is  found  upon 
examination,  to  be  crossed  by  a  number  of  dark  lines.  If  the 
source  of  light  be  changed,  the  spectrum  changes  with  it.  In 
the  spectrum  of  the  white  light  of  a  candle,  for  instance,  or  that 
of  the  oxyhydrogen  lime  light,  the  dark  lines  vanish  and  we  have 
a  continuous  spectrum.  Again,  if  light  from  an  incandescent 
gas  01-  vapor  be  examined,  we  get,  in  general,  a  spectrum  con- 
sisting of  a  definite  number  of  bright  lines  on  a  dark  ground. 
Kvery  gas  or  vapor  yields  a  different  and  quite  characteristic 
spectrum.  The  salt  of  sodium  burned  in  a  Bunsen  flame,  will 
cause  the  flame  to  become  yellow,  and  the  spectrum  consists  of 
two  narrow  lines  of  yellow  light.  Similarly  potassium  gives  a 
violet  flame,  and  two  bright  lines  in  the  red  and  one  in  the  violet 
of  the  solar  spectrum.  Strontium  colors  the  flame  red,  and  has 
a  number  of  lines  in  the  red,  one  in  the  orange  and  one  in  the 
blue  portion  of  the  spectrum. 

Though  perhaps  having  no  direct  bearing  upon  the  color 
problem  as  it  concerns  our  subject,  it  is  of  interest  to  note  that 
these  bright  lines,  in  the  spectrum  of  the  various  substances 
mentioned,  correspond,  in  position,  to  certain  of  the  dark  lines 
of  the  solar  spectrum,  and  it  has  been  established  that  the  dark 
lines  indicate  the  presence  of  these  metals  in  question  in  the 
sun.  As  said  before,  when  white  light  falls  on  a  relatively  cool 
gas,  the  gas  absorbs  these  rays  that  it  would  itself  emit  in  incan- 
descence. Thus  we  might  have  in  a  room,  a  source  of  light 
giving  out  all  possible  waves  of  light,  from  red  to  violet.  If 
this  light  were  led  through  a  screen  of  sodium  vapor,  the  screen 
would  absorb  those  rays  whose  wave  lengths  corresponded  to 


310  CAST  GOLD  AND  PORCELAIN  INLAYS 

the  bright  sodium  lines  in  the  yellow  part  of  the  spectrum. 
These  rays  being  removed,  there  would  be  left  two  dark  lines 
in  their  places.  This  is  precisely  what  happens  in  the  case  of 
solar  spectrum.  The  sun  is  a  source,  giving  out  light  of  all 
possible  wave  lengths;  as  the  light  passes  through  the  sun's 
atmosphere,  it  encounters,  say,  the  vapor  of  sodium.  This  vapor 
absorbs  the  rays  whose  wave  lengths  correspond  to  the  yellow 
lines  of  the  sodium  spectrum  and  leaves  dark  lines  in  their 
places  in  the  solar  spectrum.  By  observing  these  absorption 
lines  in  the  solar  and  stellar  spectra,  the  presence  of  various 
terrestrial  elements  have  been  proved  in  the  sun  and  the  stars. 

The  refractive  index  of  a  transparent  medium  is  different 
for  different  kinds  of  light.  When  white  light  passes  through  a 
prism,  the  different  colored  rays  of  which  it  is  composed  are 
bent  at  varying  angles  from  the  original  common  source  of 
direction. 

They  are  said  to  be  dispersed.  The  dispersion  for  the 
given  prism  depends  upon  the  difference  of  the  refractive  in- 
dices of  the  extreme  rays  of  the  visible  spectrum.  It  varies 
with  the  substance  and  the  angle  of  the  prism.  In  general  rays 
of  short  wave  length  are  more  refracted  than  rays  of  long  wave 
length,  but  in  some  refracting  media  this  law  partly  breaks 
down,  and  the  dispersion  is  then  known  as  anomalous  disper- 
sion. (Ref. :  Schellenon,  "Spectral  Analyses,"  Marshall  Watts, 
"Spectrum  Analysis,"  Baly,  "Specroscopy.") 

The  impact  of  ether  waves  of  a  certain  particular  frequency 
induces  in  the  eye  a  particular  color.  Color  then  is  a  sensation 
and  really  has  no  material  existence. 

The  eye  can  recognize  no  other  waves  save  those  having  a 
frequency  of  from  392  to  757  billion  per  second.  Within  this 
range,  each  number,  each  frequency  has  its  own  color.  The  ex- 
treme visible  red  of  the  rainbow  or  spectrum  is  produced  by 
about  392  billion;  the  extreme  violet  by  about  757  billion  vibra- 
tions per  second.  Between  these  the  eye  may  rest  upon  certain 
distinctive  colors;  and  the  frequencies  corresponding  to  the 
respective  colors  are: 

Red,  492-4;  orange  red,  484-1 ;  orange,  503-3;  orange  yellow, 
511-2;  yellow,  517-5;  green,  570;  blue  green,  591-4;  cyan  blue, 
606;  blue,  635.2;  violet  blue,  685.8;  pure  blue,  740.5  billion  per 
second. 


PHEXO.M  KXA    OF    LICIIT    AXI)    COLOR  311 

Light  due  to  wave  motion  of  one  simple  frequency  would 
be  homogeneous,  or  monochromatic,  light.  If  it  were  visible,  it 
would  produce  the  simplest  color  sensation.  The  light  of  burn- 
ing sodium  is  a  compound  of  two  yellow  lights  corresponding  to 
their  respective  wave  frequencies  of  508.9  to  510.6  billion  vibra- 
tions per  second;  and  this  is  the  nearest  we  have  as  yet  reached 
to  monochromatic  light. 

The  eye  takes  up  any  congeries  of  monochromatic  light 
impinging  simultaneously  upon  the  same  spot  in  the  retina, 
anil  the  resulting  sensation  is  always  that  of  a  single  color,  not 
necessarily  resembling  any  of  the  components. 

(irern  (uid  riolct  lif/Jtt  blended  in  different  proportions 
Itmrlucc  all  ///c  niti'nin'diatc  blues.  Nearly  every  example  of 
what  we  call  colored  light  is  in  reality  an  admixture  of  several 
monochromatic  lights. 

White  light  is  usually  due  to  a  simultaneous  impact  of  wave 
motions  of  all  visible  frequencies;  but  the  sensation  of  whiteness 
may  be  produced  by  the  simultaneous  impact  on  the  retina  of 
two  suitable  spectral  colors  such  as  yellow  and  ultra-marine 
blue. 

Colors  vary  in  line,  in  purity  and  in  luminosity.  The  hue 
determines  the  name. 

The  purity  or  absence  of  admixture  with  Avhite  light  de- 
termines its  richness  (i.  e.,  vermilion  reflects  80  per  cent  of  red 
light  mixed  with  20  per  cent  of  white). 

The  luminosity  or  brightness  determines  the  shade  or  tone 
of  color. 

Interference  with  any  of  these  will  cause  a  sensation  of  the 
impression  produced  upon  the  retina  with  a  corresponding  vari- 
ation in  the  color. 

The  color  of  transparent  objects  is  due  to  selective  ab- 
sorption. A  red  object  seen  through  greenish  blue  glass  ap- 
pears black;  greenish  blue  glass  absorbs  the  light  from  the  red 
object. 

Hold  the  same  piece  of  glass  up  to  the  sky,  and  the  red 
lights  which  are  components  of  the  white  light  of  "day"  are 
cut  off;  what  light  passes  through  will  produce  a  sensation  of 
greenish  blue. 

The  color  of  a  transparent  body  will  also  apparently  de- 


312  CAST  GOLD  AND  PORCELAIN  INLAYS 

pend  upon  the  thickness  of  tlie  layer  examined;  a  thin  layer  of 
iodine  vapor  appears  in  daylight  to  be  purple;  a  thicker  layer 
appears  blue. 

Before  a  nonluminous  object  can  be  seen  otherwise  than  by 
transmitted  light,  it  must  reflect  light;  if  it  does  not  it  will  ap- 
pear black.  Pour  a  colored  liquid  into  a  deep  black  vessel,  it 
Avill  reflect  no  light  to  the  eye  of  the  observer.  It  absorbs  all 
the  light  and  reflects  none. 

Sprinkle  a  white  powder  into  the  vessel  onto  the  surface 
of  the  liquid.  White  light  enters  the  vessel,  it  is  reflected  in 
all  directions  by  the  powder,  but  it  is  in  part  absorbed  by  the 
liquid  and  the  color  of  the  liquid  is  revealed. 

Of  exactly  the  same  kind  is  the  reflection  of  light  by  a  solid 
object.  Bodies  allow  light  to  traverse  them  to  a  very  small 
depth,  and  then  by  internal  reflection  the  light  is  turned  back  in 
all  directions;  absorption  comes  into  play,  the  result  being  that 
the  object  appears  to  have  a  definite  color. 

If  the  light  supplied  to  an  object  contains  none  of  the  kinds 
of  light  which  it  can  reflect,  the  object  appears  black,  or  color- 
less; flowers  looked  at  by  the  yellow  light  of  burning  sodium 
will  appear  colorless  or  black  unless  the  flowers  are  yellow; 
surface  reflection  modifying  the  result.  Color  is  not  always  due 
to  selective  absorption.  A  haze  is  blue  if  it  consists  of  fine 
enough  particles;  these  cause  repeated  reflection  and  at  each 
reflection  the  light  becomes  bluer;  because  these  rays  which 
would  have  been  most  refracted  (the  blue  and  the  violet)  are 
most  largely  reflected.  The  color  of  the  sky  is  that  of  a  haze 
reflecting  light  downward.  (Ref. :  A.  H.  Church  on  "Color," 
1887;  and  "Colour"  by  C.  T.  "Whitmell,  1888.) 

There  are  three  primary  colors  and  these  plus  a  modifier 
are  all  the  equipment  the  porcelain  worker  really  needs,  lie 
may  for  convenience  use  several  shades  of  the  three  primaries. 

A  primary  color  is  that  which  can  not  be  made  by  combining 
other  colors. 

The  three  primaries  are  yellow,  red,  and  blue.  These  may 
be  considered  the  three  colors  of  creation  and  they  are  analogous 
to  light,  heat,  and  shade. 

Yellow  represents  light,  life,  and  activity;  and  red  repre- 
sents color  or  warmth,  or  richness,  if  you  please. 


PHENOMENA    OF    LIGHT   AND    COLOR  313 

Blue  represents  shade  or  tone. 

The  modifiers  are  white  and  black,  which  arc  considered  the 
acme  of  light  and  shade. 

AYhite  or  black  should  not  be  considered  as  colors.  It  seems 
foolish,  and  it  is  foolish  that  assertions  are  made,  first,  that  a 
certain  combination  of  colors  will  produce  white  and  then  that 
the  same  combination  of  colors  will  result  in  black. 

For  some  time  a  color  wheel  was  a  part  of  school  equip- 
ment, designed  to  demonstrate  that  white  was  a  combination  of 
all  colors. 

The  three  primary  colors,  yellow,  red,  and  blue  were  placed 
on  the  disk,  and  it  was  revolved  at  high  speed.  But  the  pri- 
mary colors  on  the  disk  were  usually  of  a  light  tone,  white  form- 
ing a  great  part  of  them,  and  the  blending  brought  about  by 
rapid  revolution  of  the  disk  resulted  in  a  disk  of  neutral  gray. 

If  we  combine  yellow,  red,  and  blue,  in  which  no  white  is 
present,  a  very  dark  shade  will  be  produced,  and  this  will  be 
the  nearest  approach  to  the  absence  of  all  colors,  but  it  will  be 
very  far  from  a  true  black. 

Any  two  primary  colors  mixed  in  equal  parts  form  a  second- 
ary color.    These  are  three  secondary  colors: 

Yellow)  ~  Red  Blue]^, 

^          [Ureen          ,.  n       mrange  -r,    ,  >  Purple 

Blue     j  i  el  low  j  Red  J 

An  important  claim  set  up  by  some  schools  that  the  three 
secondary  colors  are  the  true  primaries,  must  be  here  combated. 

When  a  green  object  is  looked  at  in  a  strong  light  until  the 
eye  is  saturated  Avith  the  color,  its  complement,  red,  is  produced 
in  the  eye,  and  if  the  eyes  are  closed  the  object  will  appear  a 
bright  red,  instead  of  green,  its  natural  color.  The  same  is 
true  of  the  others.  Purple  will  produce  yellow  in  the  eye,  and 
orange  will  produce  blue.  Hence  the  claim  of  primaries  for  the 
secondaries. 

But  a  more  careful  study  and  observation  will  show  the 
fallacy  of  such  claim. 

The  action  of  complementary  colors  is  always  reciprocal, 
and  the  reverse  action  of  these  colors  is  much  more  marked. 

Red  will  produce  green  in  the  eye  much  more  quickly  and 
brilliantly  than  green  will  produce  red. 


314  CAST  GOLD  AXD  POKCELAIX  INLAYS 

Yellow  will  produce,  or,  rather,  induce  purple,  and  blue 
will  induce  orange  in  the  eye  much  more  quickly  than  the 
reverse. 

That  there  is  one  action  of  color  in  light  and  another  in 
pigment  is  not  correct.  The  action  is  the  same  in  both. 

Sanford  proves  this  by  the  following  experiment : 

From  a  piece  of  thin  looking-glass,  cut  a  couple  of  little 
mirrors  one-fourth  of  an  inch  in  width  and  an  inch  in  length; 
stick  pins  in  lengthwise  through  two  small  corks  and  glue  the 
backs  of  the  mirrors  on  to  the  tops  of  the  corks  over  the  heads 
of  the  pins,  so  they  may  be  stuck  into  paper  and  set  at  any 
desired  angle.  Throw  the  prismatic  colors  through  a  prism 
onto  a  sheet  of  white  paper  on  the  wall,  and  place  another  sheet 
of  white  paper  on  the  wall  opposite  the  sheet  upon  which  the 
colors  are  shown.  To  prove  that  green  is  a  secondary  color  in 
light,  as  well  as  in  pigment,  produce  it  from  the  adjoining  color 
on  each  side,  blue  and  yellow.  Stick  the  mirrors  one  in  pure 
blue,  reflecting  it  onto  the  white  paper  opposite;  and  the  other 
in  pure  yellow,  throwing  them  together  on  the  opposite  paper, 
the  same  green  shown  by  the  prism  will  be  produced.  The 
same  experiment  should  then  be  made  with  the  mirrors  in  yellow 
and  red  for  orange,  and  in  blue  and  red  for  purple.  This  fully 
establishes  the  secondary  character  of  the  three  colors,  for  no 
one  who  has  carefully  studied  this  subject  will  assert  that  a 
color  produced  by  combining  two  other  colors  is  in  any  sense 
a  primary  one. 

Now  try  the  opposite  experiment  of  producing  the  blue  by 
combining  the  adjacent  colors  on  each  side  "the  purple  and 
the  green, ' '  and  the  yellow  by  combining  green  and  orange,  and 
the  red  by  combining  orange  and  purple,  or  any  other  combina- 
tion you  may  wish  to  try.  Note  the  utter  failure  of  the  experi- 
ments and  you  will  be  convinced  that  red,  blue,  and  yellow  are 
the  true  and  only  primaries  in  light  and  pigments. 

Two  secondary  colors,  combined  in  equal  parts,  produce 
a  tertiary  color.  It  may  be  produced  directly  from  the  primary 
colors,  by  mixing  all  three  together  in  the  proportion  of  two 
parts  of  one  to  one  part  each  of  the  other  two;  tertiaries  are 
citrine,  russet,  and  olive. 


PRIMARIES 

Yellow 
Yellow 


PJIKXO.MKXA    OK    J.ICIIT    AX1)    COLOIt 
TERTIARY  SECONDARY 

Orange  - 


315 


Citrine 


Russet 


Blue 
Blue 


•Green 


•Orange 


-Purple 


Purple 


Green 


PRIMARY 

-Yellow 
-Red 


This  is  as  far  as  the  analysis  of  color  can  proceed,  because 
if  two  tertiaries  were  to  be  joined  for  a  quaternary,  it  would  be 
the  combining-  of  the  three  primaries  in  almost  equal  propor- 
tion, and  so  we  would  get  an  approximate  absence  of  color. 

Only  two  primary  colors  are  combined  simultaneously  in 
the  prism  or  rainbow;  for  this  reason  no  tertiary  colors  are 
present  in  prismatic  or  rainbow  colors. 

An  intermediate  color  is  a  color  between  a  primary  color 
and  a  secondary  color,  and  is  made  by  combining  a  primary  and 
a  secondary  in  equal  parts ;  or  it  may  be  made  directly  from  the 
primary  colors  by  mixing  two  primaries  in  the  proportion  of 
three  parts  of  one  to  one  part  of  the  other.  There  are  six  inter- 
mediate colors:  sulphur  (yellow-green) ;  saffron  (yellow-orange) ; 
nasturtium  (red-orange) ;  garnet  (red-purple) ;  campanula  (blue- 
purple) ;  and  turquoise  (blue-green). 

These  six  intermediate  colors  arc  usually  divided  into  a 
grade  of  five  shades  ranging  from  the  primary  to  the  secondary 
between  which  each  color  stands,  and  this  graduation,  together 
with  the  multitude  of  shades  of  primaries  and  secondaries,  pro- 
vides an  endless  variety  of  color. 


316 


CAST  GOLD  AXD  PORCELAIN  IXLAVS 


A. 

B. 

C. 

D. 

E. 

F. 

G. 

H. 

I. 

J. 

K, 

L. 

M. 

N. 

0. 


Fig.   305. 

Yellow,  primary. 
Bed,  primary. 
Blue,   primary. 

Purple,  secondary  =:  one  part  S  +  one  part  C. 
Orange,  secondary  =  one  part  B  -f-  one  part     I . 
Green,  secondary  —  one  part  C  +  oue  part  A. 
Olive,  tertiary  —  one  part  D  +  one  part  F. 
Russet,  tertiary  —  one  part  D  +  one  part  E. 
Citrine,  tertiary  =  one  part  E  -f  one  part  F. 
Sulphur,  intermediate.     3A  +  \B  +  W,  or  1A  +  IF. 
Turquoise,   intermediate.      3C  +  1J,   or    IF-flC. 
Campanula,  intermediate.     3(7  +  IB,  or  D  +  C. 
Garnet  or  red  purple,  intermediate.     37?  +  1C. 
Nasturtium,  intermediate.     3-B-f  L-l.  or  IB +  17?. 
Saffron,  intermediate.     ?,A  +  1B,  or  1.1, +  17?. 


I'lIKXOMKXA    OK    UlillT    AND    COI.OI!  .'!17 

Complete  Chart  of  the  Prismatic,  or  Rainbow,  Colors 

It  will  be  noted  that  both  in  the  color  guide  and  in  the 
prismatic  chart,  indigo  does  not  appear,  although  it  was  in- 
cluded by  all  colorists  from  Xewton's  time  up  to  1890,  when 
the  discovery  was  made  that,  being-  a  combination  of  black  and 
blue1,  indigo  never  had  been  present  and  should  not  be  included 
in  the  prismatic  colors. 

As  will  be  readily  seen,  all  colors  come  from  the  three 
primary  colors,  red,  yellow  and  blue.  The  secondary  and  inter- 
mediate colors  are  formed  in  the  prism  or  rainbow  by  a  blend- 
ing of  the  primary  colors;  the  red  and  yellow  blending  together 
and  forming  all  grades  of  orange,  from  red-orange  to  yellow- 
orange;  and  the  yellow  and  blue  blending  together  into  all 
shades  of  green,  from  yellow-green  to  blue-green.  Purple  is 
formed  both  at  the  top  and  bottom  of  the  rainbow,  by  reflection 
of  the  red  and  blue,  which  are  refracted  out  of  a  direct  line,  and 
consequently  reflected  on  the  inner  surface  of  the  prism  or  rain- 
bow as  shown  in  the  chart,  the  red  being  reflected  from  the  bot- 
tom into  the  blue  at  the  top,  thus  forming  purple.  Violet  is 
purple  in  a  diluted  form,  and  as  it  is  a  reflected  color  in  the  rain- 
how,  and  consequently  weak,  may  reasonably  be  called  violet, 
but  is  in  reality  purple. 

The  blue  is  also  reflected  into  the  red,  and  produces  pur- 
ple at  the  bottom.  Colorists,  not  having  looked  for  this,  have 
failed  to  observe  it,  but  it  may  be  plainly  seen  in  any  bright 
rainbow. 

The  red  reflecting  into  the  blue  at  the  top  produces  all 
grades  of  purple  between  pure  purple  and  red-purple.  It  will 
thus  be  seen  that  all  colors  appear  in  the  prismatic  or  rainbow 
colors,  excepting  the  tertiary  colors — citrine,  russet,  and  olive 
—which,  being  a  simultaneous  combination  of  all  three  .primary 
colors,  cannot  themselves  exist  in  the  prismatic  colors. 

Harmony  of  Colors 

The  way  color  affects  the  eye  is  not  only  very  interesting, 
but  is  very  important  to  every  person  who  has  eyes.  When 
the  eye  looks  at  a  color,  not  the  color  itself  but  its  opposite, 
called  its  complementary  color,  is  absorbed  by  the  eye,  and  if 


318  CAST    GOLt)    AND    1'OltCKLAlX    .IX LAVS 

the  eyes  are  closed,  the  object  will  be  seen,  not  in  the  color 
the  eye  saw  when  open,  but  in  its  complementary  color.  If  a 
red  color  is  looked  at  until  the  eye  is  saturated  with  the  color, 
and  the  eyes  are  closed,  the  object  will  be  seen,  not  in  red,  but 
in  a  bright  green.  If  the  eye  sees  a  bright  yellow  until  it  is 
filled  with  the  color,  it  will  be  seen  with  closed  eyes  in  a  rich 
purple.  Therefore  when  one  color  is  seen  it  is  important  that 
the  next  color  looked  at  shall  harmonize  with  the  color  Nature 
has  formed  in  the  eye,  or  an  unpleasant  shock  will  be  expe- 
rienced and  the  pleasing  sensation  of  harmony  destroyed  just 
as  effectually  as  a  clash  of  sounds  shock  the  ear. 

This  creation  of  the  complementary  color  is  not  confined 
to  the  eye  alone,  but  all  Nature  capable  of  reflecting  color 
shows  the  same  action;  for  example,  a  yellow  sunset  reflects 
purple  in  all  cloud  and  snow  shadows. 

The  matter  of  complementary  color  is  a  simple  one,  not  dif- 
ficult to  understand,  and  everyone  should  learn  it. 

To  each  color  there  is  one  other  color  which  is  comple- 
mentary. A  complementary  color  is  one  which  supplies  what  is 
lacking  in  the  other;  for  example,  green,  which  contains  yel- 
low and  blue,  lacks  red,  therefore,  red  supplies  what  is  lack- 
ing in  green  and  is  its  complement,  and,  vice  versa,  green  is 
the  complement  of  red. 

In  every  case  complementary  colors  are  reciprocally  com- 
plements of  each  other.  In  the  color  guide,  the  complementary 
colors  are  shown  opposite  each  other.  lied  and  green  are  com- 
plements, as  are  yellow  and  purple,  as  well  as  blue  and  orange. 
It  becomes  a  simple  matter  of  remembering  these  three  sets  of 
complements  and  learning  to  balance  shade  for  shade,  and  tint 
for  tint. 

The  more  delicate  these  balances,  the  more  subtle  and  ex- 
quisite may  be  the  effect  of  color  harmony  upon  the  eye. 

Rule  1. — Complementary  colors,  when  placed  side  by  side, 
brighten  each  other. 

It  is  important  to  understand  well  the  following  simple, 
natural  principles.  As  has  been  stated,  each  color  produces 
its  complement  in  the  eye.  If  one  looks  at  red,  green  is  created 
in  the  eye.  This  is  not  a  delusion  but  a  practical  fact.  If  one 
has  seen  red,  and  there  is  consequently  green  in  the  eye,  if 


P1IKXO.MKXA    OF    LKJIIT    AM)    COLoll  .')!!) 

the  eye  turn  I'roiu  red  to  green,  that  is,  if  the  ga/e  be  quickly 
shifted  from  a  red  to  a  green  surface,  tlie  green  which  has  been 
produced  in  the  eye  by  the  red,  will  add  to  the  green  we  are 
looking  at  and  it  will  appear  more  brilliant  than  it  would  have 
appeared  if  the  eye  had  not  just  been  looking  at  red.  This  ex- 
plains the  principle  of  the  first  rule  in  the  harmony  of  color. 
It  will  thus  be  understood  that  if  brilliancy  of  color  is  desired 
it  must  be  attained  by  the  application  of  this  principle.  Two 
complementary  colors  must  in  some  way  be  so  arranged  as  to 
appear  in  juxtaposition. 

Itule  2. — Complementary  colors,  when  mixed  together,  kill 
each  other. 

We  must  now  come  to  the  matter  of  subduing  instead  of 
heightening  color,  which  may  easily  be  done  by  observing  an- 
other action  of  Nature.  The  same  color  which,  if  placed  be- 
side a  color,  will  brighten  it,  if  mixed,  will  kill  it.  If  red  be  too 
red,  green  is  the  only  color  that  will  take  the  redness  out,  or 
subdue  it;  and,  vice  versa,  if  green  be  too  green,  red  is  the  only 
color  that  can  subdue  the  greenness. 

This  fact  is  of  equal  force  with  every  other  color;  red  and 
green  are  complements  and  will  not  only  brighten  each  other  in 
juxtaposition,  but  will  negate  each  other  when  mixed  together. 
The  same  is  true  of  yellow  and  purple  and  of  blue  and  orange. 

By  observing  these  rules,  any  desired  effect  in  the  harmony 
of  color  may  be  produced;  a  color  may  be  heightened  by  the 
simple  method  of  placing  its  complement  next  to  it;  or  sub- 
dued (if  less  brilliancy  is  desired)  by  mixing  its  complement 
with  it.  The  symphony  of  practically  one  color  produces  the 
complement  in  the  eye,  and  if  this  created  complement  is  not 
neutralized  by  the  actual  presence  of  the  same  color,  it  blends 
in  the  eye  with  the  local  color  and  subdues  it. 

The  range  of  complementary  colors  is  not  wide  and  com- 
plex, but  very  simple  and  confined  strictly  to  the  three  pri- 
maries, the  three  secondaries  and  the  intermediate  colors. 

If  a  color  be  a  primary,  a  secondary  is  its  complement.  If 
a  color  be  a  secondary,  a  primary  is  its  complement. 

If  a  primary  color  has  but  a  small  amount  of  another  pri- 
mary in  it,  thus  turning  the  predominating  color  a  little  away 
from  the  primary,  its  complement  will  contain  just  as  much 


320 


CAST    GOLD    AND    PORCELAIX    1XLAYS 


INTERMEDIATE  COLORS 


Yellow 

Yellow 
Yellow 


Yellow 
Yellow 


Campanula' 


-Blue 

(Secondary)      (Primary) 
-Purple  -  Blue:Red 


Turquoise 


Blue 


(Secondary)   Yellow  and 
reen  -         \  Blue 


Sulphur  or  Yellow^jreen 

{Secondary) 

reen  -  Yellow  and  Blue 


Saffron 


(Secondary) 
•Orange     Yellow  and  Red 


Nasturtium 


arnet 


(Secondary) 

Orange  -  Yellow  and  Red 


-Red 


(Secondary) 
—  Purple-  Red  and  Blue 


PHKXOMF.XA    OK    LIC1IT    AND    COLOR 

more  of  the  remaining  third  primary.  For  example:  It'  red  has 
a  little  yellow  in  it,  turning  it  toward  nasturtium,  or  red-orange, 
its  complement  green,  must  have  just  that  much  more  blue  in 
its  composition,  turning  it  toward  turquoise,  or  blue-green.  In 
this  way  the  six  interim  diary  colors  may  be  complements. 

A  fact  to  be  remembered  in  the  harmony  of  colors  is  that 
white  or  black  added  to  any  one  of  the  primaries,  produces  two 
colors  of  quite  opposite  i  ITect,  that  always  harmonize  with  each 
other,  as  they  are  virtually  light  and  dark  of  the  same  color. 

AYhite  added  to  yellow  will  produce  straw,  or  cream,  color, 
according  to  the  yellow  used:  and  black  added  to  yellow  pro- 
duces olive,  therefore,  straw,  or  cream,  and  olive  produce  pink; 
black  added  to  red  produces  maroon;  hence  pink  and  maroon 
will  always  harmonize. 

White  added  to  blue  produces  azure;  black  added  to  blue 
produces  indigo;  hence  a/ure  and  indigo  will  always  harmonize. 


CHAPTER  XXI 
THE  PORCELAIN  INLAY 

If  we  now  take  up  the  consideration  of  the  porcelain  inlay 
as  a  distant  operation  by  itself  and  not  in  combination  with 
gold,  we  shall  find  ourselves  compelled  to  designate  the  indica- 
tion and  contraindication  for  the  performance  of  this  operation, 
and  we  find  that  the  best  general  rule  that  may  be  laid  down 
would  resolve  itself  into  dogmatically  stating  that  porcelain 
must  be  used  where  gold  would  be  objectionable  because  of 
esthetic  reasons.  In  other  words,  all  the  surfaces  of  decayed 
teeth  which  would  upon  being  restored  be  exposed  to  view,  must 
be  filled  with  a  material  which  will  not  be  objectionable  to  the 
eye,  providing  the  conservation  of  the  teeth  would  be  brought 
about  to  a  satisfactory  degree.  On  the  other  hand,  another  prin- 
ciple that  might  be  almost  general  in  its  application  is  in  my 
opinion,  well  stated  in  this  following  sentence:  No  occlusal  sur- 
face of  any  tooth  which  would  upon  restoration  be  opposed  by 
a  natural  dental  organ,  should  be  restored  by  porcelain,  when 
other  materials  may  be  had  for  that  purpose. 

I  realize  that  I  lay  myself  open  to  severe  criticism  on  the 
part  of  those  who  blindly  and  fanatically  follow  the  porcelain 
call,  but  I  would  call  the  attention  of  the  practitioner  and  the 
student  to  the  fact  that  properly  fused,  porcelain  is  infinitely 
harder  in  texture  and  resistance  than  the  natural  tooth  enamel, 
and  so  under  the  stress  of  mastication  the  latter  will  suffer  by 
attrition,  and  the  damage  created  will  far  outweigh  the  tem- 
porary esthetic  satisfaction  obtained  by  the  operator  in  com- 
pleting his  operation  in  the  material  mentioned. 

It  is  far  better  to  restore  the  occlusal  surface  of  natural 
teeth  which  have  decayed  in  a  material  that  is  somewhat  softer 
or  more  yielding  than  the  natural  tooth  enamel,  and  thus  run 
the  risk  of  having  to  perform  the  operation  again  rather  than 
endanger  the  integrity  of  teeth  that  are  in  no  way  involved 
by  decay.  It  would  seem  too  that  porcelain  is  a  material  pecu- 

322 


THE    POItCKLAIX    INLAY  323 

liarly  adapted  to  replacing  those  parts  of  natural  teeth  that 
are  in  close  proximity  to  the  gum  tissue,  and  the  reason  for 
that  may  be  found  in  the  fact  that  porcelain  is  very  dense,  and 
may  be  fused  to  a  very  high  polish,  so  that  upon  cementation 
into  place,  it  will  present  no  rough  surfaces  for  any  ferment 
products  to  attach  themselves  to  and  so  invade  the  vulnerable 
gum  tissue  area. 

Byram,  in  an  elaborate  monograph  on  the  subject  of  por- 
celain inlay  work,  practically  concedes  to  porcelain  the  realm 
of  the  entire  mouth,  preferring  it  to  any  other  filling  material, 
but  I  think  that  he  was  mistaken  in  his  deductions  and  in  his 
conclusions,  for  the  reason  stated  above. 

The  dental  porcelains  as  we  use  them  are  composed  of 
silex,  kaolin,  and  feldspar,  fluxes  and  pigments,  or  coloring 
matter. 

Silex  is  an  oxide  of  silicon,  an  infusible  substance  insol- 
uble in  all  acids  except  hydrofluoric,  slightly  soluble  in  caustic 
alkalies,  and  forms  about  14  per  cent  of  the  basal  mass  of 
porcelain.  It  adds  to  its  strength  and  gives  it  a  translucent 
appearance. 

Kaolin  or  silicon  of  aluminum,  consists  of  an  aluminum  ox- 
ide, silicon  oxide  and  water,  sometimes  spoken  of  as  disinte- 
grated feldspar.  Through  natural  decomposition  feldspar  loses 
its  potassium  oxide  by  the  action  of  water  and  other  agents. 
Kaolin  forms  about  4.5  per  cent  of  the  porcelain.  It  is  a  highly 
refractory  clay  when  heated  alone,  but  readily  unites  with 
feldspar  when  mixed  with  it.  It  supplies  the  porcelain  with 
stability  of  form,  which  permits  it  to  be  molded  and  carved  be- 
fore being  fused. 

Feldspar  is  a  duplicate  silicate  of  aluminum  and  potassium. 
In  other  words,  it  is  composed  of  aluminum  oxide,  potassium 
oxide,  and  silicon  oxide,  so  that  it  would  seem  that  the  differ- 
ence between  feldspar  and  kaolin  is  the  possession  by  the  for- 
mer of  potassium  oxide,  and  the  possession  of  kaolin  of  the 
water  of  crystallization.  Feldspar  composes  about  82  per  cent 
of  the  basal  mass  of  porcelain,  a  highly  refractory  material, 
almost  infusible  in  ordinary  electric  furnaces. 

In  order  to  increase  the  fusibility  of  this  basal  porcelain 
and  make  it  possible  for  the  general  practitioner  to  use  it  in  his 


324  CAST  GOLD  AXD  PORCELAIN  IX LAVS 

practice,  fluxes  are  added;  such  substances  as  sodium  borate 
(Na2B4O7);  sodium  carbonate  (Na2C03);  potassium  carbonate 
(K2CO3),  or  glass  which  contains  oxides  of  potassium  or  sodium 
forming  the  greater  part.  All  these  fluxes  are  ground  together 
with  the  porcelain;  then  upon  fusing  a  chemical  change  takes 
place  forming  an  indefinite  compound,  from  which  none  of  the 
original  ingredients  can  be  removed  except  by  some  process 
which  involves  the  destruction  of  other  ingredients. 

The  pigments  or  coloring  matters  most  commonly  used  in 
the  manufacture  of  dental  porcelain  are  precipitated  gold,  plat- 
inum, purple  of  Cassius  (the  oxide  of  gold  and  tin),  the  oxides 
of  gold,  titanium,  manganese,  and  silver.  The  colors  produced 
by  the  use  of  these  pigments  in  varying  proportions  are  hues 
of  red,  yellow,  blue,  green,  brown  and  gray. 

Dental  porcelain  may  be  divided  into  high-  and  low-fusing 
porcelain.  High-fusing  porcelain  is  one  that  will  fuse  above 
the  melting  point  of  pure  gold,  and  low-fusing  porcelain  some- 
where below  that  point. 

By  ram  states  that  any  enamel  body  can  be  fused  on  pure 
gold  providing  enough  time  is  given.  Some  low-fusing  porce- 
lain will  fuse  above  the  fusing  point  of  pure  gold,  provided 
the  requisite  heat  to  fuse  pure  gold  is  obtained  rapidly. 

He  also  adds  that  while  the  above  distinction  seems  to  meet 
all  practical  requirements,  it  is  unscientific  and  its  only  value 
is  to  make  a  convenient  distinction  between  the  two  classes  of 
porcelain  for  practical  usage. 

He  also  makes  the  following  distinction  between  high-  and 
low-fusing  porcelain:  High-fusing  porcelains  require  more  than 
five  minutes  to  fuse,  while  low-fusing  porcelains  require  less 
than  five  minutes  to  fuse  at  2,000°  F.  It  is  impossible  to  fuse 
any  of  the  high-fusing  porcelains  at  2,000°  F.  in  five  minutes, 
and  it  is  also  impossible  to  keep  any  of  the  low-fusing  porce- 
lains in  contact  with  a  heat  of  2,000°  F.  for  five  minutes  with- 
out becoming  overfused. 

He  divides  porcelain  bodies  into  basal,  or  foundation,  bod- 
ies, enamel  bodies,  and  glazes.  All  basal  and  foundation  bod- 
ies he  says  are  high-fusing  porcelains,  while  enamel  bodies  and 
glazes  are  either  high-  or  low-fusing  porcelains. 

The  basal  bodies  are  used  in  crown  and  bridge  work  for  the 


THE   PORCELAIN    I  XI. AY 

construction  of  hand-carved  teeth,  and  they  require  a  specially 
constructed  furnace  in  order  to  maintain  the  intense  heal 
needed  to  fuse  them.  The  foundation  and  enamel  bodies  might 
meet  the  requirements  for  inlay  work  and  it  is  best  for  the 
operator  who  intends  to  perfect  himself  in  this  work,  to  limit 
his  experiments  to  these  latter  bodies.  These  porcelains  used 
for  inlay  work  may  be  mixed  with  alcohol  or  they  may  be 
mixed  with  water.  The  latter  process  gives  a  body  more  easily 
carved  than  the  former. 

From  an  elaborate  series  of  experiments  Byram  deducted 
the  following: 

1.  Porcelain  has  no  definite  fusing  point. 

2.  By  prolonging  the  time  of  exposing  to  heat,  a  thoroughly 
fused  porcelain  may  be  obtained  at  a  comparatively  low  tem- 
perature.   I  do  not  agree  with  Byram  in  this  respect;  at  least 
I  contend  that  the  reasoning  of  Byram  in  this  instance  was  in- 
correct, and  that  the  amount  of  heat  present  in  the  electric  fur- 
nace muffle  at  the  time  of  the  fusing  of  that  porcelain  was 
greater  than  was  indicated  upon  the  pyrometer  or  other  instru- 
ment used  by  Byram  in  determining  his  degree  of  heat.     The 
effect  of  heat  upon  the  porcelain  is  cumulative,  and  the  vibra- 
tions  of  the  heat  waves  in  themselves  tend  to  create  heat  plus, 
and  thus  even  though  the  degree  indicated  upon  his  instrument 
was  lower  than  he  thought  would  be  required  to  fuse  that  por- 
celain, he  must  have  of  necessity  been  in  possession  within  his 
muffle  of  the  requisite  amount  of  heat  to  fuse  the  mass.     So  I 
would  rather  have  it  understood  by  the  student  that  the  sec- 
ond deduction  of  Byram  is  not  an  axiomatic  truth. 

3.  ''Porcelains  fused  at  a  lower  temperature  and  for  a 
longer  time  will  maintain  their  characteristic  color,  and  will  be 
more  homogeneous  in  texture,"  which  I  would  rather  have  read 
as  follows:  ''The  more  carefully  porcelains  are  fused  and  the 
more  slowly  the  heat  is  allowed  to  permeate  them  until  they 
reach  the  fusing  point,  the  more  homogeneous  will  they  be  in 
texture,  and  the  more  certain  they  will  be  in  color." 

4.  Low-fusing  porcelains  can  be  made  of  high-fusing  porce- 
lain by  repeated  fusing  and  grinding;  which,  while  perhaps  true, 
seems  to  be  an  anomaly  when  we  consider  the  fact  that  each 
fusing  and  grinding  disposes  of  part  of  the  flux,   and  so  we 


326  CAST  GOLD  AND  POKCKLAIX  IX LAVS 

have  ultimately  the  basal  bodies  or  the  enamel  bodies  to  deal 
with,  both  of  which  are  highly  refractory  compounds  not  read- 
ily subject  to  fusing. 

5.  If  a  piece  of  porcelain  is  thoroughly  fused  and  more 
porcelain  is  added  and  fused,  the  first  layer  will  be  slightly  over- 
fused.    In  the  process  of  applying  porcelain  in  layers  and  fus- 
ing each  layer,  the  underlying  layers  will  be  slightly  overfused 
and  somewhat  lighter  in  color,  which  should  carry  the  warning 
to  the  student  that  porcelain  restorations  should  be  biscuited 
until  the  required  amount  of  bulk,  outline,  and  contour  has  been 
obtained,  and  that  the  porcelain  restoration  must  be  fused  only 
once. 

6.  A  small  mass  of  porcelain  is  more  readily  affected  by 
heat  than  a  larger  one,  and  as  the  size  of  the  mass  of  porcelain 
increases,  just  in  that  ratio  does  the  length  of  time  necessary  to 
fuse  it  increase. 

7.  Porcelains  containing  a  large  percentage  of  flux  are  more 
easily  affected  by  bubbles  than  those  that  are  more  nearly  com- 
posed of  the  basal  ingredients.     Very  readily  comprehended 
when  we  realize  that  the  tendency  of  all  fluxes  is  to  leave  the 
porcelain  in  the  form  of  gases  and  that  these  gases  forcing  them- 
selves into  and  between  the  molecular  spaces  of  the  porcelain, 
prevent  homogenous  arrangement  of  the  molecules. 

8.  It  is  more  difficult  to  maintain  the  characteristic  color 
of  low-fusing  than  high-fusing  porcelains  when  held  for  a  long 
time  at  the  maximum  heat  required  to  fuse  them. 

9.  Low-fusing  porcelains  are  denser,  have  greater  shrink- 
age, and  less  tensile  strength  than  high-fusing  porcelains. 

10.  By  repeated  heating  of  porcelain  to  the  point  of  high 
biscuiting,  it  will  finally  become  fused  and  maintain  its  charac- 
teristic color. 

11.  High-fusing  porcelains  shrink  from  15  to  25  per  cent, 
while  low-fusing  porcelains  shrink  from  20  to  35  per  cent. 

There  is  an  error  in  the  ninth  and  eleventh  deductions 
which,  because  of  their  unimportance  to  the  student,  will  not 
be  taken  up. 

12.  A  coarsely  ground  porcelain  fuses  at  a  higher  tem- 
perature and  shrinks  less  than  one  of  the  same  formula  finely 
ground. 


THE    PORCELAIN    IX  LAV  327 

13.  The  amount  of  shrinkage  of  any  porcelain  will  in  a 
measure  be  dependent  upon  the  consistency  to  which  it  is  mixed 
and  the  density  to   which   it   is  condensed;  the  thin  mixture 
showing  more  shrinkage  than  that  of  the  putty-like  consistency. 

14.  Underfused  porcelain  is  more  opaque.    Overfused  por- 
celain becomes  lighter  and  tends  to  become  more  transparent. 
( )verfused  porcelain  loses  in  strength  in  proportion  as  the  tem- 
perature is  increased. 

15.  The  tendency  of  both  high-  and  low-fusing  porcelain  is 
to  assume  spheroidal  form  when  overfused,  and  if  considerably 
overfuseil  they  tend  to  form  an  amorphous  mass  of  glass. 

]>yram  quotes  the  following  advantages  for  porcelain  as  a 
filling  material: 

1.  Fillings  can  be  inserted  much  more  nearly  harmonious 
with  the  natural  teeth. 

'2.  Porcelain  is  a  poor  conductor  of  thermal  changes  and 
a  nonconductor  of  electricity. 

3.  The  margins  of  cavities  pro  peril/   ( ?)   filled  with  por- 
celain are  not  readily  attacked  by  caries. 

4.  The  cement  used  as  a  retaining  medium  giving  the  fill- 
ing the  greatest  adhesion  of  all  of  the  filling  materials  except 
cement. 

.").  The  patient  is  relieved  of  sitting  with  a  rubber  dam 
adjusted  over  the  mouth  for  periods  of  considerable  length  and 
of  the  pain  incident  to  adjusting  the  rubber  dam  and  cervical 
clamps  for  cavities  extending  beneath  the  gum. 

6.  The  nervous  strain  on  both  the  patient  and  the  dentist 
is  lessened,  thereby  relieving  the  patient  of  the  shock  which 
usually  follows  long  and  tedious  operations. 

7.  If  a  porcelain  filling  is  faulty,  it  is  easily  displaced,  and 
the  patient  knows  immediately  that  the  services  of  a  dentist 
are  required. 

Among  the  disadvantages  of  porcelain  as  a  filling  material, 
he  states: 

1.  The  friability  of  porcelain  causes  it  to  fracture  readily, 
thereby  excluding  it  from  any  form  of  cavity  that  cannot  be 
so  prepared  that  the  overlying  margins  of  the  filling  material 
can  be  formed  or  else  protected  from  strain. 

'2.    It  is  impossible  to  bevel  the  cavity  sometimes  to  protect 


328  CAST  GOLD  AXD  PORCELAIN  IXLAVS 

the  enamel.  The  relative  strength  of  the  porcelain  and  enamel 
are  approximately  the  same,  so  that  one  cannot  protect  the 
other. 

3.  It  is  difficult  to  match  the  color  of  the  natural  teeth. 
This  always  has  been  and  always  will  be  the  most  serious  dis- 
advantage of  porcelain  as  a  filling  material  and  until  we  under- 
stand more  thoroughly  the  general  phenomena  of  color  forma- 
tion, we  may  expect  to  be  disappointed  with  many  of  our  in- 
lays. 

4.  The  cement  used  as  a  retaining  material  may  cause  a 
change  in  the  color  of  the  tooth  or  of  the  inlay.    This,  however, 
may  be  largely  overcome  by  the  application  of  correct  prin- 
ciples in  cavity  preparation. 

5.  The  cement  will  dissolve  unless  there  is  only  a  thin  film 
used  as  a  retaining  medium.     This  is  not  so  much  a  disadvan- 
tage to  the  skillful  operator,  for  if  the  margins  are  defective  he 
will  remove  the  defect  by  making  a  new  inlay;  but  to  the  in- 
competent or  careless  operator  this  will  always  be  a  disadvan- 
tage because  any  cement  now  produced  will  dissolve  from  the 
margins  of  an  ill-fitting  inlay. 

As  to  the  applicability  of  porcelain  as  a  filling  material,  it 
will,  in  my  opinion,  prove  confusing  to  quote  Byram  on  this 
subject,  and  it  will  be  best  for  the  student  to  bear  in  mind  that 
the  writer  considers  porcelain  applicable  in  simple  cavities  only, 
except  in  the  six  anterior  teeth  where  compound  cavities,  that, 
is,  cavities  involving  more  than  one  surface  of  a  tooth,  may  be 
filled  with  this  material.  No  compound  cavities  in  bicuspids  or 
molars  should  be  filled  with  porcelain. 

CAVITY  PREPARATION 

The  preparation  of  simple  cavities  for  the  reception  of 
porcelain  inlays  has  already  been  outlined  in  this  work.  It  will, 
however,  be  best  to  reiterate  that  the  walls  of  these  simple 
cavities  must  diverge  so  that  the  floor  of  the  cavity  shall  form 
with  the  walls  of  the  cavity  an  angle  of  at  least  one  hundred 
degrees.  This  will  insure  a  more  perfect  seating  of  the  inlay 
in  the  cavity  than  could  be  obtained  if  the  walls  and  floor  of  the 
cavity  formed  a  right  angle.  It  must  be  readily  apparent  that 


THE    PORCELAIN'    I  X  I  -A  Y  !')l) 

a  platinum  or  a  gold  matrix  occupies  sonic  spare,  and  since  the 
porcelain  must  be  baked  in  a  matrix  and  that  matrix  subse- 
quently stripped  off  the  porcelain  inlay,  some  space  will  be 
present  between  the  cavity  and  the  inlay,  which  space  is  subse- 
quently tilled  by  cement.  If  then  the  walls  and  floor  of  the 
cavil  v  are  at  a  right  angle  to  each  other,  there  will  be  a  cement 
line  showing  all  around  the  inlay.  If,  however,  the  floor  and 
walls  of  the  cavity  are  at  an  obtuse  angle  to  each  other,  upon 
the  removal  of  the  platinum,  the  inlay  will  be  allowed  to  seat 
itself  further  into  the  cavity  and  because  of  its  wedge  forma- 
tion (of  obtuse  angle  formation)  will  more  closely  seal  the  cav- 
ity at  its  external  or  marginal  surface.  This  will  sometimes 
entirely  obliterate  any  evidence  of  cement  except  that  the  latter 
will  show  under  a  magnifying  glass. 

In  preparing  compound  cavities  in  anterior  teeth  for  por- 
celain inlays,  we  have  the  same  factors  entering  into  the  cavity 
preparation  which  are  present  in  the  preparation  of  cavities 
for  gold  inlays;  that  is: 

1.  The  surgical  or  operative  factor  which  means  the  actual 
cutting  of  tooth   structure   (including  the  extirpation  of  the 
pulp)  and  the  proper  filling  and  treatment  of  the  root  canals. 

2.  The  mechanical  or  formative  factor  which  means  that 
mode  of  tooth  structure  cutting  which  brings  it  when  cut  into 
the  Held  of  physics,  mechanics,  geometry,  and  mathematics. 

3.  The  alterative  factor  which  means  the  factor  tending  to 
produce  a  change  from  decrepit  or  abnormal  to  a  healthy  con- 
dition because  of  its  restoration  to  proper  physical  relation  to 
the  surrounding  tissues. 

In  order  to  present  the  three  factors  mentioned,  a  cavity 
for  the  reception  of  a  compound  anterior  porcelain  inlay  must 
comply  with  the  following  requirements: 

It  must  offer  a  series  of  angles  and  surfaces  best  suited  to 
resist  stress  or  tendency  to  fracture  of  the  tooth. 

It  must  present  margins  so  prepared  as  to  best  conserve 
the  enamel  structure  of  the  tooth,  which  in  this  instance  means 
that  the  enamel  margins  must  be  square  and  not  beveled. 

It  must  offer  a  ready  access  for  the  making  of  the  matrix 
or  for  the  taking  of  the  impression,  in  order  to  construct  a  die 
upon  which  to  swage  the  matrix. 


330 


CAST  GOLD  AND  PORCELAIN  INLAYS 


It  must  offer  a  retentive  receptacle  and  support  to  the 
inlay. 

It  must  offer  a  series  of  angles  and  surfaces  best  suited  to 
resist  the  constant  tendency  to  dislodge  the  inlay. 

It  must  present  margins  so  prepared  that  the  finished  op- 
eration will  conform  as  nearly  as  possible  to  the  highest  con- 
ception of  beauty  of  form. 

It  must  present  a  form  for  the  reception  of  the  inlay  which 


Fig.  306. 

shall  bring  the  various  margins  into  areas  of  comparative  im- 
munities. 

For  the  proper  instruments,  refer  to  Chapter  V,  Fig.  8,  on 
cavity  preparation  for  gold  inlays,  where  also  will  be  found  the 
general  rules  for  tooth  cutting,  etc. 

Dr.  F.  T.  Van  Woert,  who  is  an  ardent  advocate  of  the  por- 
celain inlay  and  of  the  indirect  method,  published  a  series  of 


THE    PORCELAIN    INLAY  331 

illustrated  articles  in  the  I)<'t/t<tl  Han*  <>f  Interest.  A  number 
of  illustrations  and  a  description  of  them  is  here  reproduced. 

Fig.  306,  A,B,  C,  and  D  shows  a  method  of  obtaining  a  sep- 
aration between  two  teeth  which  are  to  be  inlayed. 

A  piece  of  ligature  silk  is  doubled,  and  by  means  of  a  floss 
silk  loop,  it  is  guided  through  the  interdental  space  below  the 
contact  point  of  the  teeth  to  be  separated.  A  loop  is  then  tied 
in  the  ligature  silk  and  the  surplus  is  cut  off  with  a  pair  of 
scissors.  The  silk  ligature  will  absorb  sufficient  moisture  to 
bring  about  a  separation  of  the  teeth. 

In  Fig.  307,  A  and  /?,  he  illustrates  a  method  of  separating, 
or  more  or  less  tilting  back  to  normal  two  teeth  which,  because 
of  extensive  caries,  lean  toward  one  another.  He  states: 

"There  are  cases  where  extensive  caries  mav  have  caused 


Fig.  307. 

the  leaning  of  two  teeth,  say  a  bicuspid  and  a  molar  (Fig.  307, 
A),  or  two  molars  necessitating  very  extensive  separation  to 
place  them  in  anything  like  a  normal  position.  In  such  cases, 
I  have  obtained  most  satisfactory  results  by  removing  the  su- 
perficial decay  and  filling  the  cavities  with  Calxine  cement  (a 
temporary  cement),  then  inserting  a  small  piece  of  seatangular 
tent  at  the  point  of  separation,  as  shown  in  Fig.  307,  B. 

"I  believe  this  method  was  devised  by  Dr.  Johnson,  of 
Brooklyn.  ]t  would  be  better  to  experiment  with  this  material 
before  putting  it  to  practical  application.  It  is  procurable  at 
most  drug  stores  or  at  any  surgical  supply  house,  and  comes  in 
the  form  of  short  pencils  in  a  variety  of  sizes.  The  expansion  is 
in  its  diameter  and  not  in  its  length." 

There  is  very  little  occasion  for  the  separation  of  teeth  in 


332 


CAST  GOLD  AND  PORCELAIN  INLAYS 


gold  inlay  work,  and  .it  should  be  used  with  great  caution  when 
used  at  all  in  any  kind  of  work  upon  the  teeth. 

I  have  seen  many  cases  of  malocclusion  and  subsequent  de- 
struction of  teeth  and  their  supporting  and  surrounding  tissues 
brought  about  by  over  enthusiastic  separation  prior  to  inser- 
tion of  contour  fillings  and  inlays. 

These  restorations  always  made  the  tooth  too  large  mesio- 
distally,  and  thus  forced  all  the  rest  of  the  teeth  in  the  mouth 
out  of  their  normal  field  of  residence  and  excursion. 

Separation  can  be  avoided  in  most  instances  by  gaining 
free  access  to  the  cavity  from  the  occlusal  surface  and  by  sane 
extension  into  areas  of  comparative  immunity. 


Fij.  S. 

Fig.  308. 

In  Fig.  308  Van  Woert  illustrates  the  preferred  manner 
of  preparation  of  a  simple  cavity  for  a  porcelain  inlay. 

For  half  of  its  depth,  the  cavity  presents  walls  perpen- 
dicular to  the  floor,  the  other  half  of  the  walls  being  divergent. 

When  the  inlay  is  finished,  a  portion  of  its  inner  part  is 
ground  off  to  allow  of  its  being  seated,  so  that  the  flaring  walls 
will  come  in  contact  with  the  tooth  structure  and  obliterate  as 
much  as  possible  the  cement  line. 

Dr.  Schreier,  of  Vienna,  recommends  the  making  of  the 
matrix  of  platinum  by  placing  the  foil  between  two  layers  of 
goldbeater's  skin,  thus  forming  a  cradle  for  the  foil  and  re- 
ducing the  chances  of  breaking  through  it  in  the  process  of 
swaging.  (See  Figs.  309,  310,  and  311.) 


T1IK    POIH'KLAI.V    [NLAY 


333 


A  very  lliin  rubber  dam  will  serve  equally  well  as  the 
outer  layer,  while  a  pie;-e  of  thin  (1hina  silk  will  take  the 
place  of  goldbeater's  skin  as  the  other  part. 

If  the  matrix  is  to  he  formed  in  the  mouth,  the  foil  is 
placed  between  the  two  layers  of  supporting  material  and 
slipped  between  the  teeth,  the  ruhher  dam  or  outer  layer  hav- 
ing been  left  somewhat  longer  so  that  the  extended  labial  and 
lingual  portions  of  it  may  be  grasped  with  the  fingers  firmly 
around  the  tooth  presenting  the  cavity. 

With  a  pair  of  foil  carriers,  the  ends  of  which  terminate 
in  a  ball,  pieces  of  spunk  or  cotton  or  small  chamois  disks  are 


Fig.   309. 


Fig.    310. 


Fig.   311, 


now  packed  carefully,  and  in  sequence,  into  the  cavity  covered 
by  the  three  layers  of  material,  that  is,  the  silk,  the  foil,  and 
the  rubber  dam. 

AY  hen  the  foil  has  been  packed  into  the  cavity  as  deeply 
as  the  circumstances  will  permit,  the  rubber  dam  may  be  dis- 
pensed with  and  the  packing  of  chamois  disks  is  renewed  to 
more  closely  adapt  the  foil  to  the  tooth. 

The  packing  is  again  removed  and  the  almost  complete 
matrix  is  carefully  lifted  from  the  goldbeater's  skin  or  China 
silk,  which,  having  served  its  purpose  to  act  as  a  cradle  for 
the  delicate  foil,  may  now  also  be  dispensed  with. 


334 


CAST    GOLD    AND    POIICKLAIX 


Fig.  312. 


Fig.   313. 


Fig.   314. 


THE    rORCKLAIX    INLAY 


335 


Fig.  315. 


Fig.  316. 


Fig    317. 


Fig.   318. 


336 


CAST    GOLD   AND    POttCELAlX    INLAYS 


The  foil  is  now  carefully  replaced  into  the  cavity,  the 
labial  and  lingual  surplus  of  it  is  tacked  with  sticky  wax  to  the 
respective  surfaces  of  the  tooth,  the  chamois  disks,  or  spunk, 
or  wet  cotton  in  the  shape  of  small  balls,  are  again  packed  into 
the  matrix  and  it  is  thus  more  and  more  closely  adapted  to  the 
floor  and  walls  of  the  cavity. 

The  packing  is  again  removed  and  the  marginal  adapta- 
tion may  be  best  completed  with  nonmetallic  instruments  of 
glass,  celluloid,  or  agate.  The  very  hard  tantalum  may  be  used. 


Fig.  319. 

The  greatest  care  should  be  exercised  so  that  the  margins 
remain  intact  and  present  a  smooth  unbuckled  appearance. 

A  small  cone  of  inlay  wax  is  softened  in  dry  heat,  and  by 
means  of  a  thin  broad,  plastic  instrument,  it  is  carefully  packed 
into  the  matrix  and  over  the  margins  of  the  cavity. 

The  tacking  of  hard  wax  is  now  removed  from  the  labial 
and  lingual  surfaces  of  the  tooth  and  the  foil  liberated. 

A  blast  of  cold  air  upon  the  tooth  will  cause  the  matrix  to 


THE    PORCELAIN     INLAY  337 

loosen  from  its  seat  ami  it  may  be  removed  from  the  mouth 
to  be  carried  into  the  investment. 

The  further  procedure  involved  in  the  construction  of  the 
porcelain  inlay  has  been  fully  described  in  the  previous  chap- 
ter on  the  gold  inlay  in  combination  with  silicate  and  porce- 
lain. 

Fig.  -'Ill*  shows  a  set  of  eight  glass  furnishers  used  in  adapt- 
ing a  foil  matrix  to  the  cavity  in  a  tooth  or  in  a  die. 

Fig.  .">!:!  shows  a  set  of  tantalum  instruments  designed  for 
this  purpose. 

Fig.  314  shows  a  small  platinum  tray  made  by  pinching 
the  four  corners  of  a  rectangular  piece  of  perforated  platinum 
.'Id-gauge  thick.  This  tray  may  be  used  as  a  carrier  or  container 
of  the  investing  material  in  which  the  matrix  is  held. 

Dr.  Van  AVoert  here  illustrates  (Figs.  315-318)  the  mixing 
of  the  silver  amalgam;  (1)  the  invested  impression  of  the  cav- 
ity: (2)  the  die  into  which  the  matrix  is  to  be  swaged;  (3)  an  in- 
>trnment  to  be  used  as  a  swager;  (4)  this  instrument  consists 
of  a  wooden  handle  which  carries  a  pointed  soft  rubber  cone, 
(i  the  soft  rubber  end,  b  the  ferrule  of  metal,  c  the  screw  fasten- 
ing this  to  the  wood.  In  Fig.  319  is  seen  the  foil  reposing  be- 
tween the  layers  of  goldbeater's  skin  and  the  application  of 
the  hand  swager. 

The  complete  adaptation  of  the  matrix  to  the  die  may  be 
brought  about  in  the  S.  S.  White  or  Ajax  swager  as  elaborated 
upon  in  a  previous  chapter. 

Figs.  320  to  371  are  taken  from  an  article  published  in  the 
/)<  ntal  Item*  <>f  Interest  written  by  Dr.  Van  AVoert,  illustrating 
a  simple  way  of  making  trays  for  carrying  compound  to  take 
impressions  of  different  types  of  cavities. 

Some  years  ago  Dr.  N.ies,  of  Brooklyn,  read  a  paper  which 
was  published  in  the  Dental  Items  of  Interest. 

He  attempted  in  that  paper  to  give  to  the  profession  a 
method  of  making  a  porcelain  inlay  without  the  use  of  a  metal 
matrix,  thus  minimizing  to  a  large  extent,  the  cement  line  in 
these  restorations.  I  feel  that  it  will  be  more  just  to  the  doctor 
to  quote  his  paper  minus  the  introduction,  practically  in  full. 


338 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Fig.   324. 


Fig.  320. — A  disto-labial  cavity  in  a  central. 

Fig.  321. — A  strip  of  platinoid  bent  at  an  obtuse  angle  and  perforated  so  as 
to  hold  the  compound  which  is  softened  in  the  flame  and  deposited  upon  the  im- 
provised tray. 

Fig.  322. — Carrying  tray  and  compound  between  the  teeth  and  forcing  the 
material  into  the  cavity. 

Fig.  323. — Lingual  view  showing  surplus  of  compound  at  a.  This  surplus  is 
removed  to  facilitate  removal  of  impression. 

Fig.  324. — Flat  straight  spatula  to  aid  in  p'acing  and  holding  impression 
material. 


THE    PORCELAIN     INLAY 


339 


Fig.  325. — A  labio-disto-lingual  cavity  in  a  lateral. 

Fig.  326. — First  step  in  formation  of  tray. 

Fig.  327. — Second  piece  of  metal. 

Fig.  328. — Improvised  slide  made  from  metal  shown  in  Fig.  327  to  fit  into 
that  shown  in  Fig.  326. 

Fig.  329.— Showing  328  on  326. 

Fig.  330. — Shows  328  carrying  compound  and  taking  impression  of  lingual 
part  of  cavity  and  all  of  distal  part.  When  the  compound  has  hardened,  all  sur- 
plus is  removed  from  the  labial  surface  and  this  surface  is  lubricated. 

Fig.  331. — Shows  328  carrying  compound  and  sliding  down  upon  326,  when 
tliis  has  hardened,  the  slide  is  raised  and  the  impression  is  removed  from  the  tooth 
in  a  lino-ual  direction.  The  slide  is  allowed  to  descend  again  until  it  reaches  its 
destination  which  is  fixed  by  the  compound.  This  will  give  an  impression  of  a  cavity 
taking  in  surfaces  of  a  tooth. 


Fig.  334. 


Fig.  333. 


Fig-.    335. 


Fig.  336. 


Fig.  337. 


Fig.    338. 


Fig.  332. — A  linguo-mesial  cavity  in  a  lateral. 

Fig.  333. — The  tray. 

Fig.  334. — The  impression. 

Fig.  335. — The  plastic  instruments  used  as  an  aid  to  project  the  compound 
into  the  cavity. 

Figs.  336,  337,  and  338. — Showing  cervical  cavity  in  a  cuspid,  the  partly  and 
completely  formed  tray. 


TIIK    POIK'KLAIX     1  X  LA  Y 


34] 


Fig.   339. 


Fig.  340. 


Fig.  341. 


Fig.   342. 


Fig.  343. 


Fig.   344. 


Fig.   345. 


Fig.  346. 


Ki-s.  339,  340,  and  341.— Showing  a  cervical  proximal  cavity  in  a  lateral  and 
the  partly  and  the  completely  formed  tray  for  taking  impression. 

Fi->.  ::»i',  :\\:\,  :M»,  :\\r>,  and  ::»»>.-  A  cervical  cavity  in  the  disto-labial  surface 
of  a  molar,  the  partly  and  the  completely  formed  tray  with  compound  in  position  on 
the  tooth  and  the  impression  of  the  cavity. 


342 


CAST  GOLD  AND  PORCELAIN  INLAYS 


Fig.  355. 


Fig.  356. 


Fig.  357. 


Figs.  347,  348,  349,  350,  and  351.— Same  as  shown  in  Figs.  340  to  349  on 
opposite  side  of  the  arch. 

Figs.  352,  353,  and  354. — A  disto-occlusal  cavity  in  an  upper  molar,  the  partly 
and  the  completely  formed  tray. 

Figs.  355,  356,  and  357. — A  labio-occlusal  cavity  in  a  molar,  the  partly  and 
the  completely  formed  tray. 


THE    FORCE LA IX     INLAY 


343 


Fig.  358. 


Fig.  3.39. 


Fig.  360. 


Fig.  361. 


Fig.  362. 


Fig.  363. 


Fig.  364. 


Fig.  365. 


Fig.   366. 


Figs.  358,  359,  and  360.— Another  type  of  disto-ocelusal  cavity  in  a  molar. 
tho  partly  and  the  completely  formed  tray  for  taking  impression. 

Figs.  361  and  362.— A  mesio-occlusal  cavity  in  a  lower  molar,  and  tray  for 
taking  impression. 

Figs.  363,  364,  365,  and  366. — A  mcsi.i-'listo-  occlusal  cavity  in  a  molar,  partly 
and  completely  formed  tray  for  carrying  the  compound  to  take  impression  of  this 
cavity. 


344 


CAST    GOLD   AND    roIIOHLAIX    INLAYS 


Fig.    367. 


Fig.   368. 


Fig.   369. 


Fig.   370. 


Fig.  371. 


Figs.  367,  368,  369,  and  370.— M.  O.  D.  cavity  in  bicuspid,  partly  and  com- 
pletely  formed  tray  for  taking  impression. 

Fig.  371. — A  handle  and  sot  of  trays,  or  cups,  which  may  be  trimmed  to  suit 
the  case,  devised  by  Dr.  Eoacli  to  facilitate  the  taking  of  impressions  of  various 
cavities. 


THE    POKCELAIX    IXLAV  .'M-.") 

"Ill  tiie  method  of  burnishing  "-old  or  platinum  foil  di- 
rectly into  the  cavity  there  is  a  nerve-racking  tediousness  to 
the  operator  and  patient — not  to  mention  pain — the  frequent 
tearing  of  the  matrix  when  almost  in  place;  the  uncertainty  of 
having  it  adapted  while  heating,  and  lastly,  its  fatal  defect- 
that  of  warping,  of  yielding  to  the  pressure  exerted  during  the 
contraction  of  fused  porcelain,  are  all  defects  inherent  in  those 
metallic  matrices. 

"Swaging  into  a  model  of  the  cavity  made  of  amalgam, 
Spence  or  Mellotte  metal  obtained  by  the  impression  method, 
while  less  trying  to  the  patient  and  operator,  does  not  relieve 
the  defects  that  obtain  in  the  porcelain  inlay  when  using  a 
metallic  matrix.  There  is  the  contraction  of  the  wax — not  as 
great  as  has  been  stated,  I  believe  with  consequent  smaller  cav- 
ities in  the  dies;  the  contraction  of  the  dies  themselves  in  some 
of  the  materials  use-d;  the  additional  space  occupied  by  the 
matrix;  the  expansion  of  the  matrix  when  heated.  Granting 
that  none  of  these  usual  errors  have  crept  in,  the  matrix,  after 
leaving  the  die,  is  still  warped  in  the  fusing  and  contraction 
of  the  porcelain.  Byram,  speaking  of  labial  and  buccal  and 
four-wall  cavities,  says:  'such  forms  of  cavities  cannot  be  pre- 
pared so  that  the  matrix  can  be  burnished  into  the  cavity  and 
the  inlay  compensate  for  the  space  of  the  matrix,  unless  it  be 
constructed  with  frail  margins  of  porcelain  which  lack  edge 
strength,  and  are  so  thin  that  change  of  color  is  noticeable 
along  those  margins.' 

"Nor  is  there  relief  found  in  swaging  over  the  cavity. 
This  method,  although  permitting  a  more  accurately  fitt.ing  in- 
lay than  any  in  use,  because  of  the  heavier  foil  it  is  possible  to 
use  (the  thickness  making  no  difference  in  this  method,  the 
thicker  matrix  offering  stouter  resistance  to  the  shrinking  por- 
celain, but  not  enough),  does  not  prevent  this  metallic  matrix 
also  being  warped  in  the  fusing.  The  advantage  of  swaging 
should  be  directly  over  the  first  impression  of  the  cavity,  tak- 
ing in  oxyphosphate  of  zinc  or  copper  when  possible. 

"It  does  not  matter  whether  the  metallic  matrix  is  directly 
burnished  into  the  cavity  or  swaged  in  or  over  dies  made  by  the 
impression  method — the  fatal  defect  of  warping  is  inherent  in 
both  methods.  The  invested  gold  matrix  has  no  advantage 


346  CAST  GOLD  AND  PORCELAIN  INLAYS 

over  the  uninvested  platinum  one  in  the  matter  of  warping. 
The  Price  method  of  burnishing  the  platinum  or  gold  foil  over 
a  stone  model  and  baking  in  the  matrix  while  it  is  in  place* 
on  the  model  has  the  same  defect  of  a  warped  matrix,  due  to 
the  fused  porcelain  contracting  while  cooling.  Xone  of  the  in- 
vestment furnished  for  this  purpose  could  hold  the  delicate  foil 
against  the  tension  of  shrinking  porcelain. 

"Every  metallic  matrix  takes  up  an  appreciable  amount 
of  space,  ranging  from  1/500  to  1/1000  of  an  inch,  which  means 
an  inlay  just  that  much  too  small  and  a  cement  line  of  that  thick- 
ness to  take  its  place,  which  often  mars  the  beauty  of  this  work. 
There  is  the  possible  distortion  caused  by  the  expanion  of  the 
gold  and  platinum  themselves.  This  may  also  contribute  to  a 
poorly  fitting  inlay. 

"I  have  felt  that  tapered  cavity  preparation  could  not  al- 
ways be  exact  enough  to  do  the  work  some  of  us  have  imagined 
it  did.  For  the  plan  to  be  entirely  satisfactory,  it  is  necessary 
that  the  margins  of  the  porcelain  inlay  project  beyond  the  nat- 
ural surface  of  the  tooth,  so  that  when  the  matrix  foil  is  re- 
moved, the  inlay  will  sink  down  and  be  just  right.  Where  it 
is  contoured  even  with  the  surface  of  the  tooth  before  the  foil 
was  disturbed  it  would  sink  below  the  surface  after  the  foil 
has  been  removed,  or  if  built  up,  it  could  only  be  at  the  center 
and  a  peak  of  cement  would  result.  The  difference  between 
diameters  of  pulpal  surface  and  outside  surface  might  also 
affect  shrinkage  unevenly.  The  smallest  deviation  from  a  geo- 
metric taper  might  prevent  the  proper  seating  of  an  inlay  made 
by  this  method. 

"Having  briefly  mentioned  the  inherent  mechanical  errors 
that  obtain  throughout  the  impression  and  die-making  process, 
which  are  later  inherited  by  the  metallic  matrix  and  its  product, 
the  porcelain  filling,  which  also  contracts,  it  must  be  apparent 
that  some  form  of  matrix  is  needed  that  will  be  free  from  the 
errors  which  the  metallic  one  possesses.  A  matrix  is  needed 
that  will  take  a  sharp  impression,  withstand  the  intense  heat 
of  a  high-fusing  porcelain,  and  maintain  its  shape  in  this  heat 
without  warping;  one  that  slightly  expands  when  set  and  does 
not  contract,  nor  on  drying  become  porous;  a  matrix  that  will 
present  smooth  surfaces,  that  will  not  vitrify  or  fuse  at  highest 


TlIK    I'nKCKl.AlX     IX  LAY  !>47 

tension  of  shrinking  porcelain  while  cooling,  and  finally,  when 
the  inlay  is  baked,  a  matrix  that  can  he  decomposed,  permitting 
the  inlay  to  he  freed  from  its  investment. 

"These  qualities  must  he  contained  in  the  ideal  matrix,  and 
are  embodied  in  the  porcelain  matrix  that  I  give  you  tonight. 
I  give  you  tonight  a  matrix  that  will  not  warp;  that  has  yield- 
ing walls;  that  does  not  tear;  that  does  not  distort;  that  occu- 
pies no  part  of  the  cavity  space;  that  admits  of  addition  and 
subtraction  of  porcelain;  and  changes  of  porcelain  shades  to 
your  heart's  content;  that  allows  repair  when  cracked  or 
chipped;  that  permits  formation  of  perfect  retention  cavities 
and  insertion  of  metallic  and  porcelain  pins  and  retainers;  that 
has  a  slight  expansion  on  setting  and  no  contraction  on  cool- 
ing; and  owing  to  the  stability  of  the  matrix,  resists  the  shrink- 
ing porcelain,  holding  it  to  its  margins  and  walls,  thereby  pro- 
ducing a  perfectly  adapted  inlay,  thus  minimizing  the  cement 
line.  Let  us  begin  and  make  an  inlay  with  this  matrix. 

"  Commence  with  me  by  gi  nerously  separating  the  teeth  to 
secure  space  for  work.  Selecting  a  German  silver  or  celluloid 
strip  the  width  of  the  tooth  and  about  five  inches  long,  bring  the 
ends  carefully  together  and  place  in  its  base  a  piece  of  soft 
rubber.  Pressing  the  walls  of  the  strip  together,  insert  this 
between  the  teeth  to  be  filled,  the  loaded  end  on  the  lingual 
side,  and  then  draw  it  up  tightly  against  these  surfaces  of  the 
teeth,  thus  molding  it.  This  I  always  try  to  do  before  trimming 
the  walls  of  the  cavity.  We  now  withdraw  it  pending  our  cavity 
preparation.  Isolate  the  tooth  or  teeth  with  a  rubber  dam; 
desensitize  it  in  any  manner  you  see  fit. 

"I  use  ethyl  chloride  put  up  in  metal  tubes.  I  hesitate  to 
mention  its  use,  since  one  of  my  dear  friends  to  whom  I  recom- 
mended it,  almost  blew  himself  up  by  handling  it  improperly. 
Before  applying  the  ethyl  chloride,  the  temperature  of  the  tooth 
should  be  lowered  by  gradually  chilling  with  a  pledget  of  cotton 
dipped  in  ether,  placed  in  the  cavity  and  evaporated  by  a  con- 
tinuous spray  of  compressed  air  under  high  pressure.  The  tube 
of  ethyl  chloride,  which  in  the  meantime  has  been  cautiously 
heated  as  warm  as  can  comfortably  be  held  in  the  hand,  is 
opened  and  the  spray  is  thrown  intermittently  on  the  tip  of  the 
tooth,  gradually  working  it  up  toward  the  neck.  The  pulp  seems 


348  CAST  GOLD  AXD  POKCKLAIX  INLAYS 

to  recede  under  this  treatment  and  is  not  injured.  I  have  used 
this  method  for  many  years,  and  have  not  known  a  pulp  to  be 
destroyed  by  it.  The  process  takes  but  a  minute.  I  mention 
desensitizing  because  it  is  absolutely  necessary  to  cut  deeply 
and  freely  to  obtain  frictional  surfaces  for  proper  retention. 

''We  now  rapidly  prepare  our  cavity  with  burrs,  small 
stones  and  polishing  disks,  doing  this  work  under  a  powerful 
glass  known  as  Loope  Stereoscopique,  which  has  the  great  ad- 
vantage of  focusing  the  vision  of  both  eyes  on  a  single  point, 
and  which  can  be  worn  over  glasses,  or  glasses  can  be  built 
into  it.  After  preparing  our  cavity  carefully  we  drill  in  a  safe 
place  a  small  depression,  which  reappearing  in  our  inlay  leaves 
on  our  inlay  a  small  papilla,  which  serves  as  a  guide  in  placing 
it.  Then  we  paint  the  cavity  with  a  small  camel 's-hair  brush 
dipped  in  pure  white  vaseline  oil — not  vaseline  or  crude  petro- 
leum. In  those  cases  when  there  is  much  saliva  this  coating 
is,  of  course,  unnecessary.  Much  has  been  said  against  the  use 
of  such  separating  oils,  but  when  one  considers  the  daily  food 
baths  of  fats  and  oils  that  teeth  are  treated  to,  I  can  see  no 
harm  in  their  use.  If  there  is  harm  in  the  use  of  petroleum,  it 
must  largely  be  due  to  the  wax  that  manufacturers  add  to  give 
it  body.  Of  course,  this  objectionable  ingredient  does  not  exist 
in  pure  vaseline  oil. 

"Here  we  depart  from  one  of  the  well-known  ways  of  mak- 
ing an  inlay,  namely,  that  of  burnishing  the  platinum  of  gold 
foil  directly  into  the  cavity.  Following  the  impression  method, 
only  so  far  as  taking  the  impression  in  wax,  or  other  impression 
compounds,  we  proceed  to  take  our  impression  in  a  wax  which 
I  have  had  especially  prepared  for  the  purpose  of  taking  im- 
pressions of  the  anterior  teeth,  largely  without  the  use  of  im- 
pression cups  or  trays.  My  object  in  doing  away  with  the  tray 
where  possible  is  that  the  space  it  occupies  is  often  sorely  needed 
to  successfully  withdraw  the  impression.  The  wax  I  have  had 
prepared  is  tough,  non-elastic,  and  contracts  only  slightly,  which 
is  easily  corrected  by  the  expansion  which  takes  place  when  we 
reheat  the  impression  to  its  workable  temperature.  It  takes  an 
impression  as  sharp  as  any,  burns  up  without  a  residue,  and 
has  a  high  melting  point.  Other  waxes  on  the  market  that  burn 
up  without  a  residue  are,  when  warmed,  found  to  be  elastic 


THE    I'OKCKLAIX    I  \  I  .A  V  ,'U!) 

and  sticky,  adhering  to  the  teeth;  they  are  brittle  when  chilled 
and  melt  at  too  low  a  temperature. 

"I  wish  to  emphasize  that  it  is  necessary  that  a  wax  have 
a  high  melting  point,  for  it  permits  greater  heat  to  be  used  in 
drying  the  poured  impression,  which  reduces  the  liability  of 
distortions  that  frequently  obtain  when  a  wax  with  a  low  melt- 
ing point  is  used.  I  am  partial  to  the  wax  impression,  and 
while  recognizing  that  wax  expands  when  heated  and  contracts 
when  chilled  under  normal  conditions,  I  am  convinced  that  the 
conditions  that  obtain  in  taking  an  impression  of  a  cavity  are 
not  those  that  obtain  when  a  bar  of  w^ax  is  measured  in  a  water 
bath  without  pressure  by  a  micrometer  arranged  expressly  for 
that  purpose.  In  the  case  of  the  impression  there  is  always  the 
forcing  into  the  cavity  of  new  wax  by  heavy  pressure  to  com- 
pensate for  the  shrinkage  in  cooling.  This  movement  of  wax 
is  possible  even  at  normal  room  temperature.  It  is  admitted 
that  the  contraction  of  gold  can  be  minimized  by  pressure.  The 
same  must  be  true  of  wax  if  clinical  results  count  for  anything. 

"To  continue,  we  take  a  small  piece  of  wax,  a  trifle  larger 
than  the  cavity,  which  we  soften  in  a  small  bowl  of  hot  water, 
held  close  to  the  patient's  face.  Now  force  the  wax  into  the 
prepared  cavity  with  fingers,  next  using  a  steel  spade-like  blade, 
which  is  passed  between  the  teeth  for  pressure  and  separation, 
introducing  now  the  German  silver  or  celluloid  strip  previously 
prepared  for  this  purpose,  which  we  tightly  draw  against  the 
wax,  and  with  strong  lateral  pressure  force  the  wax  into  the 
cavity,  making  our  tooth  contour  at  the  same  time.  When  too 
large,  we  cut  it  away  and  trim  with  a  sharp  instrument,  always 
reheating  the  wax  with  a  hot  napkin  to  remold  it.  Some  of  the 
inlay  waxes  can  be  used  for  impressions.  The  contraction  of 
these  materials  is  said  to  be  considerable,  but  I  question  whether 
the  greater  part  is  not  overcome  by  the  forcing  of  more  wax 
into  the  cavity  as  it  contracts  in  cooling,  and  later  when  ex- 
panding the  impression  by  heat.  In  all  bicuspids  and  molars 
I  prefer  a  cup  to  hold  my  impression  material  and  furnish  me 
means  of  pressing  home  my  wax.  With  pressure  at  right  angle 
we  secure  perfect  adaptation  of  the  impression  material  to  our 
edges,  using  preferably  cups  made  for  each  case  of  platinoid  of 
28,  30  or  35  gauge. 


350  CAST  (JOLT)  AND  PORCELAIN  INLAYS 

"The  sot  soon  in  my  exhibit  has  kindly  been  made  for  me 
by  Dr.  F.  T.  Van  AYoert,  of  Brooklyn.  Some  of  the  brass  cups 
•devised  by  Dr.  Price  have  many  excellent  features.  These  I 
have  also  mounted  for  your  inspection.  The  use  of  modeling 
compounds  is  not  practical  with  the  porcelain  matrix,  because 
this  matrix  material  takes  time  to  set  and  is  hardened  by  heating. 
Many  of  the  impression  compounds,  which  contain  shellac  with 
whiting  as  a  base,  swell  and  form  gases  when  heated,  which 
distort  the  impression  beyond  all  usefulness  before  the  matrix 
has  had  time  to  set.  It  shall  give  you  later  in  my  paper,  how- 
ever, a  convenient  material,  Avhich  would  be  ideal  could  its  con- 
traction be  controlled,  that  can  be  used  with  these  impression 
compounds. 

"A  splendid  impression  could  also  be  taken  with  oxyphos- 
phates.  Before  inserting  cement  in  the  cavity,  test  withdraw- 
als should  first  be  made  with  modeling  compound.  After  all 
the  undercuts  shown  to  be  present  have  been  removed  or  filled 
with  cement,  the  cavity  is  painted  with  vaseline  oil  and  the  ce- 
ment pressed  into  the  cavity  with  instruments  dipped  in  alco- 
hol. The  impression  should  be  withdrawn  as  soon  as  it  is  suf- 
ficiently hard  to  handle.  An  advantage  of  this  material  is  that 
it  can  be  fractured  for  withdrawal  and  later  united  by  addi- 
tional cement. 

"AVhere  it  is  possible  to  take  the  bite  and  impression  to- 
gether, it  is  advisable  to  do  so,  the  wax  filling  made  first  and 
removed  adhering  to  the  bite. 

"We  proceed  in  the  case  of  wax  impressions  with  cups  to 
support  the  frail  edges  of  the  impression  by  embedding  it  in  a 
plate  of  softened  wax  Avhose  melting  point  is  lower  than  the 
piece  which  we  are  investing.  This  procedure  is  necessary  to 
prevent  these  tiny  impressions  from  being  engulfed  and  dis- 
appearing below  the  surface  of  the  pouring  composition.  AATith 
a  thermometer  as  a  guide,  we  place  our  impression  next  to  a 
stove  and  heat  it  almost  to  the  temperature  at  which  it  was 
when  we  introduced  it  into  the  cavity.  This  temperature  was 
determined  by  a  bath  thermometer  immersed  in  the  same  cup 
with  the  wax.  One  reading  suffices  for  the  whole  box  of  wax. 
The  wax  impressions  need  110  treatment.  The  cement  impres- 
sions, however,  are  covered  with  a  solution  of  gutta  to  prevent 


THE     I'ORCKLAIX     1  X  I  .A  V  .'!.">] 

chemical  action  between  tlic  matrix  material  and  the  impression 
material. 

44 Wo  have  now  readied  the  point  where  we  abandon  the 
metallic  matrix  for  the  porcelain  matrix.  It  is  a  porcelain 
matrix  because  the  materials  that  enter  into  its  composition  are 
those  that  enter  into  the  composition  of  porcelain,  namely,  sili- 
cate of  aluminum  and  free  aluminum  and  lime,  which  on  treat- 
ment with  phosphoric  acid  form  phosphate  of  lime  and  alum- 
inum, which  gives  this  mixture  setting  qualities.  The  difference 
between  this  matrix  material  and  many  porcelains  is  the  ab- 
sence of  the  feldspar  and  the  llnxes,  which  are  incorporated  in 
the  porcelains  to  increase  their  fusibility;  for  example,  such  sub- 
stances as  sodium  carbonate,  potassium  carbonate,  sodium  bo- 
rate,  or  glass.  These  fluxes  would  be  fatal  to  the  porcelain 
matrix,  because  their  presence  would  cause  the  aggregates  in 
its  composition  to  vitrify  or  fuse,  thus  coat  them  with  an  insol- 
uble glaze,  making  it  very  difficult  for  the  decomposing  mixture 
to  enter  the  interstices  between  the  atoms  of  the  matrix  to  dis- 
integrate it.  The  phosphate  of  lime  and  aluminum,  which  is 
slowly  soluble  in  the  decomposing  mixture,  would  be  protected 
by  the  coating,  and  would  not  be  acted  upon,  thus  making  it 
impossible  to  free  the  inlay. 

"The  matrix  powders  are  finely  ground,  separately  mixed 
in  the  right  proportions,  and  heated  to  a  bright  red  heat  to 
expel  all  water,  both  free  and  combined.  The  mass  is  then 
finely  ground  to  impalpable  powder  and  is  ready  for  use  by 
mixing  with  dilute  glacial  phosphoric  acid. 

"I  found  this  material  so  difficult  to  properly  prepare,  with- 
out adequate  laboratory  facilities,  that  it  has  been  necessary 
for  me  to  secure  the  services  of  a  chemist. 

"  We  are  now  prepared  to  pour  our  matrix.  On  a  glass  five 
by  five  we  place  our  materials,  mixing  thoroughly  with  bone, 
glass,  or  gold  spatula,  to  a  thick  workable  consistency.  With 
a  tiny  brush  we  pick  up  this  mixture  and  paint  our  impression 
with  it,  adding  thereto  until  the  impression  is  coated.  Now 
thicken  the  mixture  and  fill  in  the  impression  with  a  thicker 
mix.  Wrap  the  impression  in  bibulous  paper  and  gently  press 
the  mixture  against  the  impression.  Leave  it  in  this  condition 
for  a  few  hours  to  set,  after  which  place  it  near  a  source  of 


CAST  GOLD  AND  PORCELAIN  INLAYS 

heat  of  some  kind  and  allow  it  to  dry  for  a  few  hours  longer. 
In  the  drying  the  advantage  of  having  a  wax  that  fuses  at 
high  temperature  is  apparent,  for  it  is  possible  to  use  a  greater 
heat  in  drying,  hence  the  better  adhesion  of  the  material.  Now 
place  the  poured  impression  in  or  on  a  stove  and  gradually 
heat  it,  to  burn  up  the  wax,  continuing  this  heat  until  the 
model  is  hard.  The  matrix  is  allowed  to  cool,  and  if  too  thick 
is  ground  down  on  a  carborundum  stone.  By  grinding  the 
matrix  as  thin  as  possible  the  decomposing  mixture  has  less 
material  to  penetrate  when  freeing  the  inlay;  the  thinner  it  is, 
the  more  quickly  the  heat  penetrates  the  matrix  and  fuses  the 
porcelain.  In  low-fusing  porcelains  the  grinding  has  the  ad- 
ditional advantage  of  so  permitting  us  to  form  the  base  that  we 
can  direct  our  porcelains  to  flow  where  we  wish. 

" 'When  the  mold  is  cold,  we  carefully  paint  the  outer  sur- 
face with  a  fine  camel 's-hair  brush  right  up  to  the  marginal 
edges  of  the  cavity  with  a  solution  of  gutta,  which  I  have  pre- 
pared for  the  purpose  of  varnishing  teeth  to  protect  them  from 
the  destructive  action  caused  by  the  wearing  of  regulating  ap- 
pliances. This  solution  I  have  adapted  to  the  additional  pur- 
pose of  varnishing  my  matrix.  It  is  made  from  balata  gum, 
from  which  the  resins  have  been  extracted  by  the  usual  wash 
roll  process.  It  is  then  dissolved  in  bisulphide  of  carbon,  washed 
in  acetone,  filtered  and  redissolved  in  chloroform.  This  makes 
a  pure  solution  of  gutta,  with  more  body  and  tougher  than 
before  obtainable.  This  gutta  has  the  valuable  faculty  of  swell- 
ing under  heat,  and  if  when  filling  your  matrix  any  unfused 
porcelain  should  happen  to  accidentally  extend  beyond  your  cav- 
ity margins,  the  swelling  gutta  largely  dislodges  the  superfluous 
porcelain  and  prevents  its  adhesion  to  the  outside  of  the  mold. 
Great  care  should  be  exercised  to  prevent  this.  After  each  bak- 
ing the  outer  surface  of  the  mold  is  revarnished. 

"We  now  prepare  to  fill  the  matrix  with  porcelain.  There 
are  numerous  ways  of  doing  this,  and  every  man  prefers  his 
own,  but  in  this  process  it  is  necessary  that  the  first  layer  in 
direct  contact  with  the  matrix  be  first  fused  or  glazed. 

"It  is  highly  important  with  the  porcelain  matrix  that  the 
mold  be  heated  gradually  and  thoroughly.  The  porcelain  should 
be  fused  by  receiving  its  heat  from  contact  with  the  walls  of 


THE    POItCKLAIN     INLAY  353 

the  matrix  rather  than  from  direct  furnace  heat  exerted  on 
the  porcelain  itself.  If  the  mold  lias  been  improperly  heated 
the  tendency  of  the  porcelain  is  to  ball  up  and  leave  the  cavity 
margins,  making  it  necessary  to  fill  in  between  the  inlay  and 
matrix — a  thing  which  we  should  <eek  1o  avoid.  If  the  mold 
is  properly  heated,  the  tendency  of  the  porcelain  is  to  cling  to 
it  and  form  a  perfect  adaptation  to  the  cavity  surfaces.  To 
bring  about  this  result  a  clay  hood  to  cover  the  matrix  while 
baking  is  absolutely  necessary,  for  it  prevents  direct  action  on 
the  porcelain  and  enables  us  to  hold  back  the  fusing  of  the 
porcelain  until  the  matrix  is  properly  heated.  In  large  con- 
tours or  long  cavities  a  thin  film  of  baked  porcelain  should  first 
cover  the  model;  then  cervical  and  incisal  ends  are  filled  and 
baked,  the  intervening  space  being  filled  later.  Filled  in  this 
way,  I  have  found  that  the  porcelain  does  not  shrink  away  from 
the  interior  surface  of  the  mold,  but  on  the  contrary  clings  to 
the  same  tenaciously,  so  that  if  any  shrinkage  takes  place,  it  is 
not  at  the  point  where  the  inlay  contacts  with  the  walls  of  the 
cavity,  but  is  in  the  interior,  which  is  later  filled  in  and  the 
piece  baked.  As  it  is  gradually  heated  so  it  is  gradually  cooled. 
Additional  porcelain  is  now  added  Avith  brush  and  spatula, 
pressing  and  forming  it  with  fingers  and  bibulous  paper.  The 
addition  of  gum  tragacanth,  mixed  in  the  water  used  to  wet  the 
porcelain,  is  a  great  help  with  some  high-  and  medium-fusing 
bodies.  I  recommend  that  medium  fusing  porcelain  be  used, 
because  there  is  no  liability  of  checking  from  contraction  with 
these  bodies,  while  with  low-fusing  porcelains  there  is,  unless 
the  cavity  is  almost  filled  with  quartz.  This  trouble  with  low 
fusing  bodies  seriously  threatened  the  success  of  my  work  until 
I  substituted  medium-  and  high-fusing  porcelains.  The  fact 
that  cracks  do  not  occur  with  low-fusing  porcelains  when  baked 
in  a  metallic  matrix  is  proof  that  the  matrix  yielded  and  was 
distorted  as  the  porcelain  contracted.  Did  the  walls  of  the  me- 
tallic matrix  hold  firm,  cracks  would  also  be  common  in  this 
type  of  inlay.  High-fusing  porcelains  contain  a  high  percentage 
of  silex  and  kaolin.  Both  of  these  materials  are  virtually  con- 
stant, adding  compression,  strength,  and  stability.  The  high- 
I'using  porcelains  having  far  less  contraction  than  the  low-fusing 
porcelains,  it  must  follow  that  the  men  who  have  been  working 


354  CAST    GOLD    AND    POKC'ELAIN    INLAYS 

with  the  high -fusing  porcelains  have  made  more  nearly  perfect 
fitting  inlays,  for  there  lias  been  less  shrinkage  to  their  material, 
and  consequently  less  distortion  to  their  matrices. 

"The  piece  having  been  repeatedly  carried  to  a  high  bis- 
cuit for  contraction — and  there  are  men  who  claim  it  must  be 
carried  to  a  glaze  to  secure  maximum  shrinkage — allowance 
should  be  made  for  the  lightening  of  the  selected  shade  by  the 
repeated  firings,  and  a  porcelain  should  be  chosen  a  few  shades 
darker  than  the  tooth.  This  rule  holds  with  labial  cavities,  but 
should  not  be  applied  to  approximal  cavities,  where  the  shade 
should  never  be  darker  than  the  tooth  in  the  mouth,  because 
when  exactly  matched  in  this  location  it  looms  darker  than  the 
tooth.  It  should  be  a  trifle  lighter. 

"Shaping  and  contouring  should  now  be  done,  and  there 
is  no  safer  means  than  the  carborundum  disk,  grade  No.  00.  It 
cuts  cleanly  and  smoothly,  and  will  not  chip  the  inlay.  Ruby, 
garnet,  emery,  or  sand  disks  should  be  used  in  inlay  work.  If 
in  the  final  fusing  it  is  not  the  exact  shade  you  seek,  the  glaze 
may  be  ground  off  with  the  same  carborundum  disk,  No.  00,  and 
a  better  shade  of  porcelain  applied  and  fused.  The  inlay  can 
also  be  removed  from  the  matrix,  tried  in  the  mouth,  rein- 
vested and  finally  glazed.  But  this  takes  time.  As  no  porce- 
lains have  a  definite  fusing  point,  they  should  be  gradually 
heated.  The  thorough  heating  of  the  mold  should  always  be 
done  before  the  point  of  high  biscuit  is  reached. 

"Earlier  in  my  paper  I  promised  to  give  you  a  material 
that  can  be  used  as  a  matrix  mold,  to  pour  into  modeling  com- 
pound impressions,  to  form  matrix  molds  to  be  used  with  low- 
fusing  porcelains.  This  material  is  no  other  than  the  oxyphos- 
phate  of  cement  that  we  have  had  on  our  shelves  the  greater 
part  of  our  lives.  It  is  mixed  in  the  usual  way  and  worked  into 
the  compound  impression,  covered  with  bibulous  paper  and 
pressed  home.  After  setting  it  is  slowly  dried  over  a  Bunsen 
burner  and  is  ready  for  use.  The  melting  point  of  this  oxy- 
phosphate  is  a  little  over  1,700°  F.,  varying  slightly  with  the  dif- 
ferent cements.  As  low-fusing  porcelains  have  no  fixed  melt- 
ing  point,  by  slowly  heating  they  can  be  glazed  at  about  1,600°  F., 
according  to  my  pyrometer.  The  compound  impression  should 
be  expanded  before  using  to  counteract  the  shrinkage.  In  mix- 


THE    PORCKLAIX     INLAY  o.V) 

ing  the  cement,  as  much  powder  should  be  incorporated  as  pos- 
sible. I  have  used  Harvard,  Ash  &  Sous'  C.A.S.,  Yyvex  and 
Ames.  Other  cements  may  be  just  as  good  for  this  purp<>--. 
but  I  have  never  tried  them.  This  is  convenient  material  that 
you  all  have  in  your  offices,  and  will  afford  you  an  opportunity 
to  test  for  yourself  the  process  I  am  giving  you  tonight.  If 
some  of  you  could  devise  a  means  of  overcoming  shrinkage  in 
this  material,  it  would  supplant  all  others  as  a  matrix  for  low- 
fusing  porcelains  in  combination  with  silex. 

"This  material  product's  a  beautiful  inlay,  and  there  is  an 
immense  saving  of  time  in  its  use.  Its  shrinkage  and  the  dan- 
ger of  melting  it  without  a  pyrometer  are  its  disadvantages. 

"Dr.  Price's  Stone  Model,  while  perfect  for  this  purpose 
in  many  respects,  is  today  almost  impossible  to  dissolve.  It 
also  melts  below  the  point  of  high-fusing  porcelains.  If  he  could 
only  overcome  these  two  difficulties,  there  would  be  a  wider  field 
for  this  valuable  material. 

"Undercuts  are  formed  on  the  matrix  by  additions  of 
matrix  material  that  leave  depressed  recesses  for  cement,  while 
metallic  tubes  and  pins  baked  in  the  inlay  can  also  be  usd. 
Cubical  crystals  of  quartz,  a  material  with'ininimum  of  expan- 
sion and  contraction,  I  frequently  use  to  form  a  crystal  sur- 
face for  adhesion  of  cement.  The  cement,  encircling  with  crys- 
tal, not  only  furnishes  an  arc  action  by  binding  around,  Tout 
also  adheres  to  each  particle,  and  by  its  own  strength  gives 
support  to  the  porcelain  that  the  voids  between  the  crystals 
might  be  thought  to  have  weakened. 

"We  know  that  maximum  density  is  maximum  strength, 
yet  where  compression  strength  is  sought — as  in  concrete  work, 
for  instance — the  maximum  of  stone  properly  shaped  with  a 
minimum  of  cement  is  recommended  by  experts  in  that  line 
and  should  hold  true  in  our  work.  The  crystals  of  quartz  are 
rolled  in  a  paste  of  porcelain  and  placed  in  the  matrix  some 
distance  from  the  margins  and  as  carefully  baked  as  if  they 
formed  the  inlay.  When  finished  and  cooled  the  voids  should 
be  filled  with  chalk  or  cement  to  prevent  the  porcelain  filtering 
through  them  and  filling  them  up. 

"The  porcelain  is  now  filled  in,  as  experience  will  guide 


356  CAST  GOLD  AXD  POECELAIX  1XLAYS 

you,  baked  in  the  prescribed  way,  and  slowly  and  gradually 
cooled  in  the  muffle  without  opening  it. 

"When  I  reached  this  step  in  working  out  my  process,  I 
found  I  had  a  filling  baked  in  a  mold  much  harder  than  my 
porcelain,  and  how  to  remove  it  safely  was  a  problem.  The 
thought  of  adding  a  separating  medium  occurred  first,  and  I  be- 
gan by  first  coating  my  mold  with  amorphous  graphite,  chalk 
and  finally  Higgin's  India  ink.  I  very  soon  found  the  carbon  in 
this  ink  burning  up  in  the  great  heat  of  my  furnace.  To  pre- 
vent this  I  introduced  a  jet  of  carbonic  acid  gas,  and  later 
hydrogen,  into  my  furnace  through  a  tube,  driving  the  oxygen 
out  of  my  muffle,  in  an  effort  to  prevent  the  oxidation  of  my 
carbon.  This  process  did  not  work  well,  and  I  found  my  inlays 
turning  green,  which  caused  me  to  suspect  traces  of  cobalt  or 
copper,  and  not  finding  any  in  the  matrix,  I  concluded  that  the 
copper  was  in  the  India  ink;  so  I  set  that  process  aside  and  took 
up  the  subject  of  a  possible  acid  solvent.  Hydrofluoric  acid, 
with  which  I  had  been  working,  naturally  suggested  itself,  and 
into  this  I  threw  my  inlay.  In  a  few  hours  I  discovered  that 
I  had  etched  my  inlay,  but  apparently  had  produced  little  or 
no  impression  on  the^  mold.  I  then  heated  the  hydrofluoric  acid 
and  was  delighted  to  see  a  softening  of  the  outer  surface  of 
the  mold.  I  left  it  overnight,  and  the  next  morning  had  the 
pleasure  of  seeing  a  trace  of  my  fast-disappearing  inlay  and  a 
small  portion  of  my  mold.  I  rescued  what  was  left,  washed 
it  in  clear  water,  and  found  that  the  acid  has  effected  a  dissolu- 
tion of  my  mold.  After  finishing  the  next  inlay  I  carefully 
coated  the  exposed  surface  with  melted  wax.  This  I  similarly 
melted  in  cold  hydrofluoric  acid,  and  then  I  succeeded  in  dis- 
integrating my  mold,  having  saved  the  glazed  surface  from  de- 
struction by  coating.  The  inside  of  my  inlay,  which  had  no  wax 
or  gutta  protection,  was  eaten  up  by  the  acid  which  had  been 
absorbed  through  the  matrix  material.  This  caused  me  to  give 
up  hydrofluoric  acid  for  this  purpose. 

"I  next  tried  a  mixture  of  equal  parts  of  nitric  and  muri- 
atic acids.  Again  covering  the  glazed  surface  of  my  inlay  with 
gutta,  I  immersed  it  in  this  solution  and  gradually  disintegrated 
the  mold.  The  time  consumed  was  four  hours,  and  many  un- 
pleasant odors  filled  my  office  and  blackened  all  the  metal  in  it. 


THE    POKCKLAIX     1X1.AY 

Finally,  after  many  trials,  I  found  the  acid  that  would  dis- 
integrate my  mold.  I  found  that  a  solution  of  one  part  hydro- 
chloric acid  to  four  of  water  is  exceedingly  effective,  cheaper, 
simpler,  and  less  dangerous  than  any  of  the  others.  AVe  now 
place  the  inlay,  coated  with  wax  or  gutta,  in  a  bottle  of  cold 
dilute  hydrochloric  acid,  leaving  it  when  possible  over  night. 
If  you  are  pressed  for  time,  the  separating  process  can  be  has- 
tened by  heating,  which  will  cause  disintegration  of  the  mold 
in  a  short  time.  A  chimney  should  be  used  to  carry  off  the 
fumes.  Even  with  this  weak  solution  of  hydrochloric  acid,  it 
is  important  that  the  inlay  be  covered  with  melted  wax  or  the 
gutta  solution  before  immersing  it,  otherwise  it  will  be  found 
that  this  weak  solution  has  acted  on  the  porcelain  and  destroyed 
its  luster.* 

"The  inlay  is  now  cleaned  with  small  burrs,  and  brushes 
dipped  in  a  solution  of  Bonsit  to  remove  any  trace  of  foreign 
material  from  its  surface.  The  inlay  is  now  ready  to  set.'* 

The  process  of  casting  porcelain  in  a  vacuum  machine  was 
successfully  accomplished  by  Dr.  F.  S.  Welden.  In  this  process, 
the  restoration  is  first  made  in  wax,  just  as  in  the  cast  gold 
inlay;  this  wax  inlay  is  then  invested  in  a  clear  white  refractory 
compound,  the  wax  is  burned  out  and  the  porcelain  fused  in 
the  crucible  of  the  flask;  when  the  mass  is  liquid,  the  valve  is 
opened  and  the  porcelain  is  sucked  into  the  mold.  It  is  ad- 
visable to  keep  playing  the  flame  upon  the  soft  mass  to  better 
fill  the  entire  mold.  The  process  never  became  popular  and  is 
now  practically  obsolete.  Further  elaboration  of  this  method 
may  he  found  in  September,  1911,  issue  of  the  Dental  Items  of 
Interest. 

Dr.  Stanly  Towle,  of  Fall  River,  Mass.,  takes  an  impression 
of  the  cavity  for  which  he  is  to  make  a  porcelain.  He  varnishes 
this  impression  and  then  runs  a  model  in  inlay  wax.  He  next 
suspends  this  model  in  hydrochloric  acid  (it  seems  to  the  author 
that  hydrofluoric  acid  should  be  used)  and  dissolves  the  cement. 
The  wax  model  is  now  cast  in  pure  gold.  He  thus  gets  a  re- 
production of  the  cavity  in  pure  gold  in  which  lie  nowT  bakes 
his  inlay. 

*I  can  not  conceive  any  advantage  In  casting  the  inlay  with  wax  or  a  solution 
of  gutta  if  we  are  going  to  subject  the  acid  medium  to  heat. 


358  CAST  GOLD  AXD  PORCELAIN  IXLAYS 

There  are  some  advantages  and  numerous  disadvantages  in 
this  method.  The  advantages  are  the  perfect  unswaged  matrix, 
the  practically  obliterated  cement  line,  the  ease  with  which  the 
matrix  may  be  handled  without  distorting  it,  and  the  conven- 
ience of  the  patient. 

The  disadvantages  may  be  enumerated  as  follows: 

The  frequent  checking  of  the  porcelain  which  comes  from 
the  different  coefficient  of  expansion  and  contraction  existing 
between  gold  and  porcelain. 

The  difficulty  of  seating  the  inlay  when  completed,  which 
may  be  obviated  by  grinding  that  part  of  the  inlay  which  enters 
the  cavity  first,  but  which  at  best  is  an  empirical  procedure. 
The  necessity  for  chemically  removing  the  matrix,  which  proc- 
ess consumes  a  great  deal  of  time  and  involves  the  handling 
of  powerful  acids,  the  fumes  of  which  are  very  unpleasant,  and 
finally  that  the  method  entails  a  sacrifice  of  time  which  is  not 
justified,  at  least  in  my  opinion,  by  the  results  obtained,  the 
latter  not  being  sufficiently  superior  to  those  obtained  by  the 
use  of  a  very  thin  matrix  material  such  as  1/2,500  foil  of  plat- 
inum. 

For  further  and  more  comprehensive  elucidation  of  the 
porcelain  problems  that  the  practitioner  may  have  to  face,  I 
am  pleased  to  refer  to  Byram's  "Principles  and  Practice  of 
Filling  Teeth  with  Porcelain,"  adding  only  my  own  chapter  on 
the  coloring  problem  of  this  phase  of  our  work. 


CHAPTER  XXII 

ExnocmxonoxTiA,  OR  THE  DUCTLESS  GLAXDS- 
THEIR  EXPRESSIOX  IN  THE  HTM  AX  MOUTH 

There  arc  many  people  who  are  perfectly  well;  their  daily 
life  is  often  one  of  intense  physical  and  mental  activity,  and  yet 
they  rarely,  if  ever,  require  therapeutics  or  mechanical  atten- 
tion. There  are  others  who  are  miserably  ill,  mentally  and  phys- 
ically, their  daily  life  is  one  of  continued  attempt  to  guard 
against  further  encroachment  by  disease.  They  are  continually 
under  the  care  of  some  one  ministering  to  some  of  their  ailments 
successfully  or  otherwise.  Some  people  for  a  period  of  time  are 
perfectly  well,  then,  for  some  obscure,  and  to  most  observers, 
unaccountable,  reason,  sicken  or  fall  seriously  ill,  to  recover  in 
the  same  obscure  and  unaccountable  manner  and  continue  to 
live  and  to  work  without  further  interference  from  disease,  for 
tlifir  allotted  numbers  of  years. 

In  corollary  with  the  above,  there  are  many  people  whose 
dental  apparatus  is  in  perfect  balance,  mechanically  expressed, 
in  perfect,  occlusion,  who  never  require  any  dental  interference; 
still  others  whose  teeth  were  in  imperfect  condition,  as  expressed 
in  malocclusion,  have  had  them  placed  in  balance,  and  subse- 
quently require  an  incessant  amount  of  dental  interference  to 
keep  on  repairing  and  replacing  parts  of  the  continually  break- 
ing down  apparatus.  Some  people  never  pay  any  attention  to 
the  cleanliness  or  the  environment  of  their  teeth,  and  yet  they 
never  need  to,  nor  do  they  seek  dental  interference  for  the  alle- 
viation of  any  dental  disorder.  There  are  others  who  are  con- 
stantly having  their  teeth  cleaned,  their  roots  scraped  and  their 
limns  scoured,  and  still  their  teeth  continue  to  present  new  cavi- 
ties, new  breakdowns,  new  dystrophies. 

Manifestly,  the  correction  of  bodily  health  and  tooth  health 
is  not  clearly  understood. 

Many  physicians,  many  surgeons,  many  dentists  will  readily 

359 


360  CAST  GOLD  AXD  PORCELAIN  IXLAYS 

admit  the  truth  of  the  foregoing'  and  attest  to  the  statement  that 
they  are  and  have  been  constantly  on  the  alert  for  some  thing, 
some  truth,  the  understanding  of  which  would  enable  them  to 
more  effectively  handle  and  efface  bodily  disorders. 

May  it  not  justly  be  said,  right  here,  that  the  cause  of  med- 
ical and  dental  ineffective  ministrations  has  been  due  to  the 
classification  of  cases  of  patients  in  the  aggregate  under  the 
heading  of  certain  diseases,  when  we  should  have  devoted  our 
attention  to  the  close  study  of  the  individual  constitution  of 
each  patient,  and  so  learn  to  treat  an  aggregate  malady  in  an 
individualized  way. 

It  is  a  fact  that  the  same  disease  will  express  itself  differ- 
ently in  different  individuals,  and  yet,  if  we  take  up  our  works 
on  therapeutics,  we  shall  find  a  woeful  lack  of  individualization 
of  cases  calling  for  treatment. 

Under  the  heading  of  "Pneumonia,"  the  pneumonia  is 
treated,  under  the  heading  of  "Diphtheria,"  antitoxin  is  advo- 
cated. Tuberculosis  has  its  prescribed  order  of  treatment,  etc. 
It  is  always  the  disease,  almost  never  the  patient. 

We  have  become  so  obsessed  with  the  pathologic  anatomy 
of  the  case  that  we  fail  to  recognize  the  ever  receding  voice  of 
God  in  the  individual,  struggling  with  all  the  normal  that  is  in 
him,  to  overcome  the  very  picture  we  take  as  a  guide  to  our 
treatment.  It  is  so  in  dentistry,  we  see  the  teeth  of  children 
decay,  and  we  either  remove  the  teeth  and  disturb  the  arch;  or 
we  fill  the  teeth  which  have  decayed,  and  allow  the  child  to  go 
with  the  predisposition  to  decay  in  the  constitution,  unrestricted 
to  work  its  further  havoc. 

We  see  a  case  of  so-called  traumatic  occlusion  and  we  begin 
to  file  and  grind  the  teeth  into  more  or  less  acceptable  stress 
relationship,  paying  no  attention  to  the  particular  "ism"  in 
that  particular  constitution  which  caused  the  arrangement  of 
teeth  ultimately  bringing  about  the  traumaism  that  sent  the 
patient  to  us  in  search  for  relief. 

A  woman  becomes  pregnant,  bears  and  gives  birth  to  a 
child,  many  of  her  teeth  begin  to  decay,  she  loses  one  or  two  of 
them,  during  the  period  of  lactation,  she  seeks  our  advice  and 
help,  and  we  dentists,  in  almost  every  instance,  fill  the  decayed 


K  X  DOCK  I X  ()!)(.)  XT  I A  361 

teeth  and  replace  the  lost  ones  and  dismiss  her  to  go  through  the 
same  dental  ordeal,  should  she  be  called  upon,  in  her  relation  as 
a  wife,  to  again  become  procreatively  active. 

A  case  of  pyorrhea  presenting  for  relief,  the  patient  is  either 
pyrocided,  vaccinated,  scaled,  scraped,  scalded,  rubbed  and 
drugged  locally,  a  few  teeth  are  lost,  being  too  far  gone;  a  few 
are  filled,  not  far  enough  gone;  a  few  are  crowned  with  golden 
caskets  and  the  bill  paid,  the  patient  is  allowed  to  go  and  take 
the  pyorrheal  potential  in  his  or  her  constitution,  the  attack 
recurs  with  renewed  virulence  and  renewed  destruction. 

Time  to  change  about  it  seems  to  me,  time  to  realize  that  we 
have  not  been  dealing  with  the  fundamental  facts  of  the  cases  in 
our  treatment  of  diseases. 

All  the  bacteriology  we  know  has  not  enabled  us  to  eliminate 
effectively  diseases  the  bacteria  of  which  we  know  best  and  are 
most  familiar  with. 

Time  to  realize  and  to  profit  from  this  realization  that  there 
are,  for  example,  any  number  of  individuals  to  whom  we  could 
feed  sandwiches  made  up  of  bread  and  pneumococci  and  who 
would  be  none  the  worse  for  the  diet.  This  is  equally  true  of 
all  germs,  not  excepting  the  most  virulent  of  streptococci. 

Some  people's  teeth  will  not  decay  in  spite  of  the  lack  of 
any  attention  on  their  part,  or  the  dentist's  part. 

Some  people  need  but  the  least  exposure  to  contract  all  sorts 
of  diseases.  Some  people's  teeth  decay  in  spite  of  all  attention. 
Some  children  never  have  any  infectious  diseases,  some  have  all 
sorts  of  afflictions. 

Wonderful  resistance  in  the  apparently  immune  specimens, 
lowered  resistance  in  the  others.  Yes,  my  friends,  but  what  is 
this  resistance  ?  Why  are  some  possessed  of  it  and  why  not  the 
others!  Where  do  they  who  have  it  get  it,  and  what  do  those 
who  suffer  lack,  in  order  to  make  it! 

Patients  have  become  habituated  to  seek  a  physician  so  he 
may  see  the  disease.  Physicians  should  become  habituated  so 
that  when  they  look  at  and  for  a  disease  they  should  see  the 
patient. 

Patients  have  become  habituated  to  go  to  the  dentist  so  he 
mav  look  at  and  after  the  teeth. 


362  CAST  GOLD  AXD  PORCELA1X  INLAYS 

Dentists  should  become  habituated  so  that  whenever  they 
look  at  a  tooth  decayed  or  healthy,  they  should  see  the  patient. 

All  this  does  not  mean  revolution,  neither  does  it  mean  a 
reactionary  program,  it  simply  means  a  broadening  of  our 
vision,  a  more  comprehensive  understanding,  and  hence  a  more 
effective  service  in  our  field  of  endeavor. 

The  endocrines  are  the  organs  of  internal  secretion. 

Endocrinology  is  the  study  of  the  organs  of  internal  secre- 
tions and  the  study  of  the  functions  of  these  organs. 

Secretion  is  a  specialized  function  of  certain  glands  made 
up  of  highly  specialized  epithelial  cells  (secreting  cells)  in  the 
exercise  of  which  function,  they  take  up  substances  from  the 
blood  stream  and  elaborate  these  substances  into  products 
wholly  at  variance  in  appearance  and  effect  with  the  substances 
which  were  taken  up,  and  discharge  these  products  by  the 
avenue  of  special  channels  or  ducts  into  various  organs  of  the 
vegetable,  animal,  or  human  economy,  to  effect  the  physiologic 
expression  of  these  organs. 

Internal  secretion  may  be  defined  in  the  same  terms,  except 
that  there  are  no  special  channels  or  ducts  through  which  the 
products  elaborated  by  the  ductless  glands  are  conveyed  to  the 
various  organs;  so  that  these  products  may  be  said  to  find  their 
way  into  the  various  parts  of  the  body  by  directly  entering  the 
blood  stream. 

The  products  of  the  ductless  glands  or  glands  of  internal 
secretion  have  been  termed  hormones  from  the  Greek  Avord,  to 
excite. 

Their  influence  upon  the  functions  of  the  various  organs  of 
the  body  is  one  of  augmentation  or  excitation  and,  under  some 
circumstances,  one  of  inhibition. 

The  potency  of  these  products  is  practically  independent  of 
quantity  and  wholly  interdependent  as  to  quality.  In  this  re- 
spect, they  are  very  much  akin,  if  not  wholly  like  enzymes  or 
ferments. 

They  are  in  such  a  fine  state  of  subdivision  that  they  may 
be  likened  to  electroatomic  messengers  communicating  and 
carrying  orders  or  directions  or  aid  from  the  vegetative  centers 
to  all  parts  of  the  body  with  which  they  communicate  at  all. 


KXIHK'KIXODOXTIA  l>()i> 

The  most  important  ductless  glands  as  we  know  them  are, 
first  the  pineal,  a  small  gland  situated  at  the  base  of  the  pituitary 
body. 

Second,  the  pituitary  body,  a  v<  ry  vascular  gland,  consiM- 
ing  of  an  anterior,  middle  and  posterior  portion,  all  situated  in 
the  sella  turcica  of  the  sphenoid  bone.  It  governs  periodicity, 
rhythm,  influences  growth,  nutrition,  reproduction,  the  psy- 
chosis, and  is  influenced  by  the  thymus,  the  thyroid,  the  gonads, 
and  the  adrenals. 

Third,  the  thyroid  gland  and  the  parathyroid  bodies.  The 
lirst  consists  of  two  lateral  lobes,  disposed  on  either  side  and  in 
front  of  the  larynx  and  upper  three  or  four  rings  of  the  trachea. 
The  parathyroid  bodies  are  arranged  on  either  side  of  the  me- 
dian line  and  may  be  found  as  low  as  the  seventh  traeheal  ring. 
The  thyroid  is  a  very  vascular  body  of  gland  tissue,  it  is  sup- 
plied by  the  superior  and  inferior  thyroidal  arteries,  which  form 
a  rich  anastomosis.  The  veins  are  correspondingly  free  and 
numerous,  they  are  valveless  and  empty  into  the  jugular  and 
innominate  veins.  It  influences  nutrition,  growth,  reproduction 
and  is  profoundly  influenced  by  functional  and  organic  disturb- 
ances of  the  alimentary  canal  and  the  gonads. 

Fourth,  the  thymus  develops  as  a  paired  sac-like  divertic- 
uluin  of  the  ventral  portion  of  the  third  and  fourth  and  possibly 
the  second  pharvngeal  cleft.  This  sac-like  beginning  of  the  thy- 
mus is  entirely  epithelial  in  structure.  It  influences  metabolism 
in  the  child,  also  the  thyroid,  the  pituitary  and  the  gonads,  and 
is  itself  markedly  affected  by  pituitary  and  adrenal  disturbances. 

Fifth,  the  suprarenal  capsules,  adrenal  bodies,  are  two 
small,  flattened,  glandular  bodies  located  in  the  back  part  of  the 
abdomen,  above  and  somewhat  anteriorly  to  the  upper  part  of 
each  kidney.  They  consist  of  a  cortical  and  medullary  portion, 
they  are  exceedingly  vascular,  with  abundant  lymph  supply. 
The  nerve  supply  is  significant,  being  derived  from  the  solar  and 
renal  plexuses  and  getting  branches  from  the  phrenic  and  pneu- 
mogastric  nerves.  Their  important  connection  with  the  sympa- 
tlutic  is  today  well  known.  Dr.  Joseph  Fraenkel  terms  the 
sympathetic  nerve  "the  frozen  adrenal"  attempting  to  convey 
the  impression  that  it  is  a  continuous  line,  icicle  as  it  were,  of 


CAST  GOLD  AXD  PORCELAIN  IXLAYS 

projected  adrenal  substance.  The  adrenals  play  a  most  import- 
ant part  in  the  development  of  the  being;  a  tremendous  part  in 
the  mental  growth  of  the  being.  Virtually,  the  great  center  of 
the  autonomic  nervous  system,  they  have  been  called  the  abdom- 
inal brain,  they  control  energy  and  the  decorative  scheme  in  the 
body;  they  have  everything  to  do  with  pigmentation,  with  oxy- 
genation  of  the  blood;  they  influence  the  thymus,  the  thyroid,  the 
pituitary  body  and  the  sexual  organs,  and  are  themselves  mark- 
edly affected  by  thyroidal,  pituitary,  and  gonadial  influences. 

Sixth,  the  gonads,  the  organs  of  immortality  on  the  pro- 
creative  plane  or  better,  the  instruments  whereby  man  perpetu- 
ates his  species  on  earth.  In  children  the  gonads  are  markedly 
influenced  by  the  thymus,  the  persistency  of  which  will  retard 
adolescence.  In  children  of  normal  development,  the  thymus 
goes  out  at  puberty  and  the  thyroid  with  its  regulating  and 
supervising  influence  comes  in.  At  that  time  also,  the  assertive 
period  of  the  gonads  becoming  manifest,  they  call  on  the  adren- 
als in  the  male  and  on  the  pituitary  in  the  female  to  set  up  an 
intercommunicating  system  of  harmonic  relations,  which  result 
in  a  most  intimate  interdependence,  very  apparent  in  the  female 
during  menstruation,  pregnancy,  childbirth,  and  lactation,  in 
the  male  during  periods  of  great  physical  stress,  excitation  or 
copulation  or  of  sublimation  of  the  procreative  urge  into  intel- 
lectual or  intuitional  poetic  expression,  in  other  words  during 
inversion  of  procreation  to  creation. 

The  foregoing  may  be  summed  up  rather  crudely  as  follows: 

Thymus — Youth. 

Thyroid — Quality  and  equilibrium. 

Pituitary — Bulk  and  disposition  (psychosis). 

Adrenal — Energy  and  decoration. 

Gonads — Immortality  or  procreation. 

Pineal — Intelligence,  soul  or  cosmic  relationship  ( ?). 

The  normal,  augmented  or  inhibited  activity  of  one  or  more 
or  all  of  these  glands  is  manifested  in  diverse  ways  in  the  human, 
dental  apparatus,  and  it  is  to  the  recognition  and  the  study  of 
these  manifestations,  that  I  have  given  the  name  of  Endocrino- 
dontia. 

The  thymotrop,  the  thyrotrop,  the  pituitotrop,  the  adreno- 


K XlKXTi I  XOI )( ) XTI A  365 

trop  and  the  gonadotrop  are  names  or  designations  appended  to 
individuals  who  exhibit  in  their  makeup,  a  preponderance  of 
thyinic,  tliyroidal,  pituitary,  adrenal,  or  gonadial  influences,  as 
the  case  may  be. 

Dr.  D.  M.  Kaplan,  the  director  of  the  laboratories  at  the 
Neurological  Institute  of  New  York,  published  an  article  in 
Endocrinology,  April,  1917.  He  called  this  article  "An  Endo- 
crine Interpretation  of  the  Dental  Apparatus." 

The  quotation  of  this  article  in  full  will  be  illuminating, 
particularly  since  I  wish  to  point  out  what  appear  to  me  to  be 
some  slight  errors  in  his  conception  and  nomenclature. 


"There  is  not  the  least  doubt  that  the  glands  producing 
internal  secretions  exert  an  influence  upon  the  exterior  of  the 
individual.  Although  the  uninitiated  still  may  consider  cer- 
tain individual  peculiarites  as  accidental,  the  endocrinologist 
knows  which  organ,  or  organs,  wrere  instrumental  in  the  produc- 
tion of  these  seemingly  accidental  phenomena.  To  ascribe  a 
certain  bodily  appearance  to  accident  is  a  confession  of  igno- 
rance, which,  however,  is  becoming  less  frequent  the  more  one 
studies  the  mystic  forces  of  the  endocrines.  The  study  of  their 
functions  can  not  be  severed  from  the  study  of  these  glands,  so 
much  so,  that  one  may  justly  call  this  specialty  an  investigation 
of  the  'compensatory  dynamics  of  the  endocrines  in  health  and 
disease. ' 

"To  understand  the  compensatory  workings  of  the  endo- 
crines is  to  know  'internal  secretions';  and  to  be  able  to  trans- 
late it  into  terms  of  physiology  and  pathology  is  to  know  how 
to  handle  your  patient  from  an  endocrine  point  of  view.  There 
are  many  external  manifestations  resulting  from  the  work  of  the 
endocrines  that  have  been  carefully  studied,  many  that  are  only 
superficially  known,  and  still  more  to  be  discovered  in  the 
future.  To  the  endocrinologist  a  pigmented  mole  is  not  an  acci- 
dent, nor  the  mustached  female  of  twenty-five,  nor  the  soft  pulse 
at  eighty,  nor  the  high  blood  pressure  at  thirty,  nor  the  enlarged, 
noninfected  tonsil.  ]t  is  the  why  and  wherefore  of  a  peculiarity 
that  is  the  constant  question  before  the  endocrinologist,  and 


366  CAST  GOLD  AND  PORCKLAIX  INLAYS 

very  often  the  answer  is  radically  opposed  to  orthodox  allopathic 
thought.  Therefore  the  uninitiated  may  be  perplexed  by  the 
stand  taken  by  the  student  of  compensatory  dynamics,  AY  ho 
argues  against  the  reduction  of  a  high  blood  pressure  in  a  cer- 
tain patient,  or  the  removal  of  the  tonsils  in  another,  and  yet  he 
may  offer  very  sound  reasons  for  both  conclusions. 

"In  his  endeavor  to  arrive  at  the  truth,  the  student  of  'com- 
pensatory dynamics'  takes  into  consideration  the  fact  that  cer- 
tain infections  have  an  affinity  or,  as  I  have  designated  it,  a 
'tropism'  for  certain  glands  with  internal  secretion.  For  in- 
stance, it  is  known  to  all  that  mumps  is  an  infectious  disease 
that  often  attacks  the  gonads.  It  has  been  noted  that  diphtheria 
and  typhoid  have  a  tendency  to  cripple  the  adrenals,  so  that 
mumps  is  known  as  a  gonadotropic  infectious  disease,  while 
diphtheria  is  an  adrenotropic. 

"There  is  also  a  definite  tropism  between  endocrine  disturb- 
ances and  the  dental  apparatus.  Ewan  "Waller,  of  Birmingham, 
England,  has  very  definitely  associated  the  teeth  in  children 
with  the  thyroid  function.  It  seems  that  the  glands  with  inter- 
nal secretions  play  an  important  role  not  only  in  the  structural, 
but  also  in  the  physiochemical  economy  of  the  individual.  A 
great  number  of  the  unclassified  subjective  disturbances  for- 
merly designated  as  neurasthenia,  neurosis,  or  hysteria,  and 
lately  as  vagotonia,  can  be  more  justly  ascribed  to  an  aberration 
or  a  disturbance  in  the  compensatory  dynamics  of  the  endo- 
crines.  The  thorough  investigator  of  the  constitution  of  an 
individual  in  health  or  disease  takes  into  account  the  phenomena 
not  only  as  pictured  in  our  books  on  diagnosis,  but  also  the  time 
of  day  or  night,  the  amelioration  or  intensification  of  symptoms 
in  the  evening,  its  involvement  of  the  right  or  left  side  of  the 
body  and  he  differentiates  where  the  same  complaint  appears  in 
the  juvenile,  adult,  or  senile  individual. 

"There  are  a  great  many  points  dismissed  by  the  uninitiated 
as  insignificant,  which  the  endocrinologist  employs  to  advantage 
in  building  up  a  picture  of  disturbed  equilibrium  in  a  patient. 
The  peculiarities  of  the  dental  apparatus  is  one  of  them. 

"  THYRODONTIA. — It  is  a  fairly  well-established  fact  that 
the  calcium  metabolism  is  governed  chiefly  by  the  thyroid  ap- 


paratus,  and  secondarily,  by  the  rest  of  the  endocrines.  The 
alkalinity  of  the  saliva  to  a  certain  extent  depends  upon  calcium 
salts.  It  is  to  he  seen  how  a  disturbed  endocrine  equilibrium 
could  bring  about  dental  decay  by  a  disturbance  in  the  calcium 
metabolism  balance,  particularly  in  children  who  depend  upon 
their  thyroid  and  thymus  more  than  the  adult  and  senile.  The 
calcium  being  deficient,  the  acids  from  food  decomposition  are 
not  neutralized,  and  the  dentine  consequently  suffers,  this  being 
one  of  the  stages  in  the  complete  breaking  down  of  the  tooth.  In 
children  particularly,  a  well-balanced  thyroid  and  sound  teeth 
go  together.  If  the  thyroid  is  not  performing  its  duties  prop- 
erly, the  tooth  to  suffer  first  is  the  molar.  The  submaxillary 
saliva  is  said  to  be  richer  in  calcium  than  the  parotid,  and  in 
view  of  the  fact  that  the  molars  lie  behind  the  duct,  their  supply 
of  immunizing  saliva  is  less  than  the  front  teeth,  and  hence,  in 
case  of  calcium  deficiency,  they  succumb  first.  This  is  mani- 
festly apparent  in  the  longer  life  of  the  lower  front  teeth  as 
compared  with  the  upper,  the  latter  not  having  the  constant 
salivary  bath  enjoyed  by  the  lower  teeth.  This  is  very  charac- 
teristically displayed  by  the  woman  with  an  exhausted  thyroid, 
due  to  repented  pregnancies,  who  invariably  loses  her  upper 
incisors.  Of  course  in  such  women  the  other  endocrines  enter 
into  the  mechanism  conducive  to  dental  loss. 

"To  start  with,  thyroid  teeth  are  distinguished  by  their 
slender  frame,  they  are  thinner,  more  transparent,  and  graceful, 
and  their  color  tends  toward  a  bluish  gray  white.  Children  and 
married  women  with  such  teeth  can  be  saved  a  great  deal  of 
dental  trouble  by  the  discreet  and  timely  administration  of 
thyroid  extract.  The  frequency  of  the  therapeutic  display  de- 
pends entirely  upon  the  case  and  the  acumen  of  the  physician. 

"In  the  multipara  the  dental  situation  from  an  endocrine 
point  of  view  is  only  partly  thyroidal.  The  interplay  and  com- 
pensatory work  of  all  of  them  are  necessary  to  help  her  through 
this  physiologic  symbiosis.  If  the  woman  is  deficient  in  any  of 
the  endocrines,  she  will  display  not  only  dental  changes,  but  all 
kinds  of  other  objective  and  subjective  manifestations  depend- 
ing upon  the  glands  or  gland  involved.  The  falling  out  of  the 
upper  incisors  independent  of  decay,  bears  a  distinct  pituitary 
stamp,  and  one  may  say  that  the  maxillary  sockets  become  too 


368  CAST  GOLD  AXD  PORCELAIN  INLAYS 

large  in  some  pregnant  women,  and  that  the  root  is  not  firmly 
implanted  in  such  a  jaw,  at  this  episode  of  partial  transient 
physiologic  aeromegaly.  It  is  the  duty  of  the  discerning  physi- 
cian, as  well  as  the  dentist,  to  guard  against  irreparable  loss, 
disfigurement  and  suffering  of  patients  by  a  timely  use  of  thy- 
roid extract  in  cases  of  dental  caries  or  late  eruption,  as  well  as 
in  gestations  that  promise  injury  to  the  teeth. 

"  PITUITODONTIA. — Many  individuals  who  are  free  from 
complaints  that  would  compel  them  to  seek  a  physician 's  advice, 
are  the  possessors  of  teeth  characteristic  of  the  acromegalic. 
The  owners  of  such  teeth  need  not  develop  aeromegaly,  never- 
theless they  must  be  regarded  as  potentially  pituitary.  Chronic 
frontal  headaches  and  the  slightest  limitation  in  the  temporal 
visual  fields,  require  very  earnest  attention  and  extremely  judi- 
cious endocrine  therapy,  for  at  such  a  stage  one  might  hold  out 
some  hope  of  deferring  the  advent  of  the  full-fledged  acromegalic 
picture.  Increase  in  size  of  the  acral  parts  is  the  chief  objective 
sign  of  this  disease  and  the  pituitary  is  the  gland  responsible  for 
its  appearance. 

"It  must  not  be  forgotten,  however,  that  not  only  an  in- 
crease, but  also  a  very  marked  diminution  in  size,  belong  to  the 
activity  of  the  pituitary  gland;  so  that  giant  and  pigmy  are 
endocrinologically  related.  The  same  applies  to  the  teeth.  The 
average  pituitary  dental  arrangement  shows  large  square  teeth ; 
oftener  than  not  the  upper  middle  incisors  are  spaced  (trema) 
and  the  rest  of  the  teeth  may  share  in  their  separation,  stopping 
at  the  bicuspids.  On  the  other  hand,  marked  overcrowding  is 
a  feature  which  also  belongs  to  the  department  of  hypophysial 
activity,  so  that  one  is  frequently  confronted  with  a  situation 
requiring  gerat  care  in  endocrine  interpretation.  The  gestating 
female  has  been  referred  to  before,  but  it  must  be  reiterated, 
that  the  falling  out  of  the  incisors,  particularly  the  lateral  one, 
has  a  double  meaning.  At  present  let  us  not  forget  that  the 
middle  upper  incisors  are  preeminently  the  teeth  closely  asso- 
ciated with  direct  primary  pituitary  function.  This  does  not 
signify  that  the  individual  has  a  pituitary  abnormality  incom- 
patible with  perfect  health;  it  may  show  itself  in  anybody  with 


KMHH'KINonoXTIA  369 

accepted  hypophysial  markings,  sucli  as  being  V(M-V  tall  or  very 
short,  having  a  very  large  head,  particularly  in  the  frontal  part, 
or  manifesting  a  tendency  to  adiposity  in  the  young  or  adult, 
with  or  without  hypogenitalism.  It  may  accompany  the  fem- 
inine type  of  man  who  shows  his  abnormality  in  his  teeth  only, 
and  his  sexual  anomaly  in  his  psychoanalysis. 

"  GOXADODOXTIA. — Individuals  with  a  gonadotropism  may 
give  in  their  history  an  attack  of  mumps  during  childhood. 
Close  relationship  between  this  contagious  disease  and  the  gen- 
ital glands  is  established  by  the  frequent  involvement  of  the 
ovary  or  testis  in  a  complicating  inflammatory  reaction.  It  is 
not  necessary  that  the  individual  previously  having  had  mumps 
should  present  earmarks  of  a  definite  gonad  disease,  he  may  yet 
show  them  in  the  future  or  not  at  all.  This  depends  entirely 
ui)on  the  compensatory  work  of  the  rest  of  the  endocrines. 

"In  all  endocrine  manifestations  not  only  the  soma,  but 
also  the  psyche  is  influenced.  Besides  these  psychic  attributes 
most  of  them  show  definite  somatic  stigmata,  of  course  not  all 
of  them,  the  exceptions  here  as  elsewhere  serving  to  establish 
the  rule. 

"In  the  gonadotropic  individual  the  dental  apparatus  car- 
ries a  very  striking  earmark  of  the  tropism.  If  the  middle  upper 
incisors  carry  a  message  from  the  pituitary,  the  lateral  upper 
incisors  certainly  do  the  same  from  the  gonads.  So  that  when 
the  gonads  are  teratologically  ab  ovo  definitely  abnormal,  one  is 
sure  to  find  some  abnormality  in  the  upper  lateral  incisors.  The 
relationship,  if  any,  is  a  crossed  one,  so  that  the  right  upper 
lateral  incisor  may  point  to  the  left  testis  or  ovary,  and  vice 
versa. 

"It  is  also  to  be  noted  that  the  greater  the  deviations  from 
normal,  the  more  definite  the  markings  in  the  dental  department, 
so  much  so,  that  the  lateral  incisors,  as  a  result  of  a  marked 
gonad  defect,  may  not  have  erupted  at  all.  Such  a  dental  situa- 
tion is  rare  indeed,  so  is  also  the  clinical  condition  presented  by 
the  patient  who  has  it.  Here  is  a  situation  that  the  gynecologist 
could  profit  by,  and  the  surgeon  add  another  sign  to  the  sig- 
nificance of  right-sided  abdominal  pain.  Such  a  pain  is  usually 
ovarian,  when  the  left  upper  lateral  incisor  is  faultily  implanted, 


370  CAST  GOLD  AND  POECELATX  INLAYS 

showing  the  mesial  edge  of  the  tooth  anteriorly,  and  protruding 
in  front  of  the  middle  incisor.  The  teeth  presumed  to  be  con- 
nected with  the  gonads  (upper  lateral  incisors)  carry  the  stamp 
of  ovarian  or  testicular  abnormality  in  their  size,  shape  or  im- 
plantation. 

"The  ovary  should  always  be  suspected  where  pelvic  pain 
is  manifested  in  a  patient  whose  lateral  incisors  are  abnormal. 
In  the  male,  small  stumpy  laterals  bespeak  sexual  impotence  on 
a  physical  basis,  many  gonorrheas,  prostatic  insufficiency,  and 
chronic  strictures.  In  such  an  individual  one  may  obtain  the 
history  of  mumps,  and  if  he  had  a  right  sided  orchitis  or  epididy- 
mitis,  more  often  than  not  his  left  upper  lateral  incisor  will  be 
differing  from  the  normal,  taking  his  entire  dental  apparatus  on 
the  standard  of  comparison. 

"On  rare  occasions  the  compensatory  work  of  the  other 
endocrines  is  so  well  adjusted  that  the  dental  anomaly  is  obliter- 
ated, and  gives  no  clue  to  the  existing  gonadopathy.  There  are, 
however,  other  external  signs  from  an  endocrine  point  of  view 
that  would  direct  attention  to  the  existing  state  of  affairs.  As 
the  dental  apparatus  is  the  subject  of  this  paper,  the  other  signs 
will  not  be  discussed. 

"There  is  a  dangerous  tendency  among  endocrinologists  to 
designate  with  peremptory  precision  that  this  or  that  organ  is 
involved,  and  is  responsible  for  the  endocrine  picture.  Very 
often  the  external  manifestations  are  caused  by  another  gland 
whose  functions  it  may  be  to  bring  about  phenomena  on  the  sur- 
face of  the  patient,  such  as,  for  instance,  the  adrenal  system;  and 
some  students  may  be  carried  away  by  this  easily  demonstrable, 
superficial  appearance,  and  be  led  to  assign  to  the  objective  find- 
ings the  place  of  first  importance;  whereas,  the  adrenals  have 
simply  acted  in  response  to  a  call  from  some  other  gland.  The 
gonads  always  require  adrenal  help  in  performing  their  work, 
and  when  they  do  not  come  up  to  the  physiologic  requirement, 
be  this  in  the  form  of  under-  or  overactivity,  the  adrenals  are 
then  called  upon  for  additional  assistance,  resulting,  secondarily 
only,  in  manifestations  appearing  on  the  skin,  mucous  mem- 
branes, hair,  etc.  The  primary,  ab  ovo,  situation  can  be  read 
from  the  teeth  and  the  gland  responsible  for  the  trouble  more 
often  than  not,  can  be  unerringly  named  and  proper  therapy  sug- 


KXIHK'RIXOnoXTIA  371 

gcsted.  It  is  remarkable  how  readily  the  patient  responds  when 
the  proper  drug  is  prescribed,  hut  IK  re,  as  elsewhere,  the  futility 
of  attempting  replacement  therapy  in  some  cases  must  be 
thoroughly  gauged. 

"A  young  woman  suffering  from  the  torture  resulting  from 
a  complete  oophorectomy  can  not  he  benefited  much  by  ovarian 
extracts,  be  it  the  whole  gland  or  the  luteal  portion.  In  some 
cases  one  must  be  able  to  read  intelligently  the  symptomatology, 
and  curb  as  much  as  possible  the  pituitary  compensation,  for  in 
such  cases,  this  is  the  gland  that  may  be  causing  much  of  the 
subjective  discomfort.  If  the  pituitary,  however,  is  not  capable 
of  compensation,  or  is  only  partly  able  to  assist,  the  adrenal  and 
thyroid  systems  are  employed  to  overcome  the  deficiency.  De- 
pending upon  the  fitness  of  these  glands  one  will  have  a  predomi- 
nating adrenal  or  thyroid  symptomatology.  Therapeutic  success 
depends  entirely  upon  our  ability  to  recognize  the  vicarious 
execution  of  functions  by  glands  with  a  different  purpose. 

"ADRENODOXTIA. — It  is  to  be  conceded  that  the  ability  to 
perform  better  work  requires  better  tools.  In  biology  this  is 
everywhere  evident.  P'rom  times  immemorial  the  longer  and 
sharper  tooth  was  part  of  the  outfit  of  the  pithecanthropus, 
whose  survival  was  assured.  Such  a  specimen  was  perhaps  also 
the  hairiest  of  the  tribe.  As  time  advanced  and  the  necessity  for 
using  the  teeth  in  offensive  and  defensive  existence  became  sec- 
ondary to  the  special  development  of  the  thumb  and  hands,  the 
chief  lighting  teeth,  the  canines,  became  shorter,  and  in  some 
very  peaceful  members  of  our  semisimian  ancestors,  also  less 
sharp.  With  the  greater  use  of  the  hand  came  the  perfection 
of  that  part  of  the  brain  that  serves  as  the  storehouse  for  memo- 
ries. These  memories  became  the  heritage  of  the  future  man, 
and  with  the  greater  specialization  of  the  hand,  the  teeth  were 
gradually  discarded  as  weapons  of  defense  and  offense.  The 
emotions  in  the  state  of  offensive  rage  still  cause  the  display 
of  them,  although  one  does  not  use  them. 

"Vasomotor  force  and  the  tone  of  muscles  depends  upon 
the  proper  work  of  the  adrenals.  Only  when  these  glands  work 
better  than  the  others,  is  it  possible  to  think  of  the  enduring 
prizefighter.  When  the  pituitary  is  equally  well  adjusted,  one 
has  the  heavy  weight  champion  type.  But  the  ability  to  scrap, 


372  CAST  GOLD  AND  PORCELAIN  IXLAYS 

whether  curbed  by  education  or  environment,  or  not,  is  indelibly 
marked  in  the  canines.  As  one  of  our  ancestors  would  have 
learned  by  experience  that  his  short  and  blunt  canine  was  no 
great  weapon  in  a  fight  and  would  have  become  the  champion  of 
peace  instead  of  conflict,  so  also  the  present  man  prefers  discre- 
tion to  valor  because  of  his  inadequate  adrenal  endowment  or,  as 
one  may  term  it,  lack  of  biologic  equipment  for  strife.  Whether 
man  or  woman,  both  show  in  a  long  sharp  canine  an  atavistic 
remnant  of  a  bellicose  progenitor,  and  upon  proper  provocation 
justify  the  above  contention. 

"Very  often  the  large  and  sharp  canine  in  a  woman  be- 
speaks the  aggressive  agitator,  public  speaker,  or  militant  suf- 
fragette. Some  of  these  women  studied  from  the  point  of  view 
of  biologic  balance  possess  other  endocrine  markings,  showing 
that  they  are  not  women  to  the  full  extent  that  nature  intended 
the  average  woman  to  be.  The  woman  whose  skin  is  rough,  who 
finds  pleasure  in  curbing  wild  horses,  who  cares  not  for  the 
duties  of  home  life,  and  who  is  an  expert  administrator  (pur- 
posely using  the  masculine)  must  give  up  a  certain  amount  of 
natural  feminism  in  order  to  be  able  to  enjoy  and  accomplish 
the  above  things.  Very  often  with  such  traits  goes  a  masculine 
hand,  a  mustached  lip,  a  large-pointed  canine,  and  a  deficient 
gonadodont.  The  sexual  psychopath  could  be  detected  by  a 
study  of  his  dental  apparatus,  and  the  endocrine  therapist  might 
supply  the  glandular  extract  that  would  give  a  more  natural 
trend  to  the  twisted  psyche  of  its  possesor. 

"The  spinster  who  truly  rejoices  in  her  single  blessedness 
does  not  do  so  from  choice,  but  rather  from  her  innate  prompt- 
ings. Being  less  of  a  woman  than  her  well-balanced  sister,  she 
does  not  require  the  society  of  a  man,  and  frequently  shows  her 
genuine  distaste  for  such  company  by  an  appropriate  remark. 
In  her  pursuits  she  wants  to  dominate  and  frequently  fills  with 
credit  a  position  requiring  great  virility.  She  abhors  the  eve- 
ning gown,  and  wears  clothes  of  a  masculine  type,  low  heels,  no 
corsets,  side  pockets,  collar,  and  tie. 

*  *  The  male  counterpart  with  short,  stumpy  and  dull  canines 
gives  up  some  of  his  primordial  male  aggressiveness,  and  be- 
comes the  Jacob  instead  of  the  hairy  Esau.  The  kitchen  is  his 
place,  he  can  sing  in  high  notes,  never  a  basso,  and  has  the 


EXDOCRIXODOXTIA  373 

greatest  inward  storms  when  the  time  comes  for  him  to  propose 
marriage  to  his  heart 's  choice.  Such  a  man  stands  a  poor  chance 
of  being  accepted  by  a  girl  well  balanced  from  an  endocrine 
standpoint.  It  is  the  one  who  will  not  enlist  to  help  defend  his 
country,  but  will  offer  a  thousand  and  one  reasons  why  he  should 
not  tight,  that  war  is  a  reversion  to  barbaric  times,  etc.  Such 
men  are  afraid  that  a  gun  might  go  off,  and  in  business  are 
equally  nonprogressive.  The  eternal  clerk,  messenger  boy,  cook, 
and  other  nonprogressive  occupations  are  theirs.  Endurance, 
progressiveness,  discovery  go  hand  in  hand  with  an  endocrine 
system  that  is  pi-rlVct,  and  a  canine  tooth  that  fears  not  to  face 
antagonism  in  any  shape  or  form. 

"The  adrenodont  in  its  structure  gives  us  a  clue  to  the  ad- 
renal balance  of  the  individual.  There  is  another  characteristic 
of  the  adrenal  tooth,  the  color.  The  grinding  surface  of  such 
teeth  shows  a  marked  reddish  brown  coloration  (Chayes),  and 
although  softer  in  texture  than  the  thyroid  or  pituitary  variety, 
they  have  a  greater  degree  of  endurance  (Chayes).  Here  again 
is  a  hint  of  the  ability  of  adrenal  secretion  to  protect.  Old  men 
or  women  will  show  short  teeth  still  in  a  very  good  state  of 
preservation  and  most  freely  marked  with  this  reddish  brown 
pigment.  Younger  people  with  such  teeth  can  be  assured  of 
their  lasting  character,  and  it  is  astonishing  to  note  how  some  of 
them  remain  intact  regardless  of  the  lack  of  care  and  the  thick 
wall  of  tartar  that  surrounds  them.  Age  or  the  ability  to  grow 
old  goes  hand  in  hand  with  proper  adrenal  work,  of  course  with 
the  assistance  of  the  other  endocrines;  and  so  adrenal  markings 
in  the  form  of  pigment  insure  not  only  the  life  of  the  tooth  but 
also  its  possessor.  Individuals  who  become  patients  on  account 
of  improper  adrenal  work  may  show  this  peculiarity  in  their 
teeth  also,  the  marking  here  indicating  the  gland  affected  as  well 
as  suggesting  the  proper  therapeutic  course  to  pursue. 

"  THYMODONTIA. — The  tooth  of  the  baby  is  bluish  porclain, 
thin  at  the  grinding  edge,  and  translucent  in  that  part.  The 
tooth  in  some  children  shows  a  tendency  to  scalloping  at  the 
grinding  edge.  This  trait  may  outlast  the  baby  and  in  rare 
occasions  be  found  in  the  adult.  The  other  infantile  character- 
istics may  go  with  it  such  as  a  red  cheek,  an  excellent  digestion 
and  a  tendency  to  diarrheas.  The  finding  of  such  teeth  in  the 


374  CAST  GOLD  AXD  PORCELAIN  IXLAYS 

adult  points  to  the  youth  of  the  individual,  regardless  of  years. 
In  this  persistence  of  juvenile  characteristics,  one  must  always 
weigh  the  compensation  offered  by  the  other  glands  with  in- 
ternal secretion. 

"The  purpose  of  this  communication  will  have  been  accom- 
plished if  the  physician  and  dentist  will  begin  to  see  in  the 
dental  apparatus  a  greater  purpose  than  the  sole  function  of 
mastication.  When  fully  studied  upon  lines  suggested  above,  a 
volume  of  facts  will  be  discovered  that  heretofore  may  have 
manv  times  been  entirely  overlooked." 


Dr.  Kaplan  calls  the  entire  ductless  gland  expression  as 
observed  in  various  individuals  "compensatory  dynamics";  I 
feel  that  this  term  will  be  misleading.  The  action  of  these 
glands,  particularly  the  adrenals,  the  thyroid,  and  the  pituitary 
is  dynamic  to  be  sure,  but  not  compensatory  in  the  true  sense 
of  the  word.  If  they  were  compensatory,  surgeons  might,  with 
impunity,  remove  any  one  of  these  glands  and  expect  the  other 
one  or  two  of  them  to  assume  the  function  of  the  one  removed. 

We  knowT  that  this  does  not  take  place.  As  a  matter  of  fact, 
the  remaining  glands  will  be  much  disturbed  in  their  expression 
of  function. 

So  close  is  the  interdependence  of  these  glands  in  their 
function,  that  not  one  may  be  hurt  or  tampered  with,  without 
immediately  calling  forth  resentment  in  the  others. 

But  interdependence  of  dynamic  expression  is  not  now  and 
ever  can  be  compensatory  dynamics,  and  Dr.  Joseph  Fraenkel 
and  his  associates,  to  wThom  most  of  us  owe  our  correct  informa- 
tion on  the  subject  of  ductless  gland  activity,  their  physiology 
and  function,  and  their  therapeutic  use  and  value,  never  meant 
to,  and  never  did,  to  me  at  least,  convey  the  information  or  im- 
pression that  they  were  compensatory  in  the  sense  in  which  Dr. 
Kaplan  seems  to  conceive  them  to  be. 

Dr.  Kaplan  is  correct  in  attributing  to  the  ductless  gland 
chain  a  marked  influence  upon  the  dental  apparatus,  its  forma- 
tion as  to  position  and  quality,  hence  resistance  to  destruction 
by  decay.  It  is  well  established,  beyond  the  necessity  for  fur- 
ther vague  experimentation,  that  the  breaking  down  of  dental 
tissues  to  wit,  teeth  and  environs,  may  be  modified  if  not  alto- 


1 :  X  DOC  R I X  QUO  X  T I A  .' ! ,  ."") 

gether,  at  least,  to  sonic  considerable  extent  by  ductless  gland 
therapy.  I  called  the  attention  of  the  profession  to  this  subject 
about  two  and  one-half  years  ago  in  my  thesis  on  the  functions 
of  the  teeth. 

Dr.  Kaplan  is  again  hasty  in  his  nomenclature.  There  is 
no  such  thing  as  thyrodontia  or  pituitodontia  or  adrenodontia, 
etc.,  any  more  than  we  could  improvise  a  science  of  pneumo- 
dontia  or  intestiiiodontia;  a  happier  name  for  his  article  would 
have  been  "Endocrinodontia,"  because  such  a  name  would  have 
covered  the  subject. 

His  remarks  regarding  the  influence  of  the  gonads  upon  the 
position  of  the  laterals  in  the  superior  maxilla1  is  correct,  but 
that  this  influence  is  a  crossed  one  has  not  been  borne  out  in  all 
experiences,  also  it  must  be  remembered  that  this  influence  is 
not  a  direct  one  but  is  exerted  through  the  pituitary. 

Thyroidal  teeth  an1  long,  well-rounded,  bell-shaped,  and  of 
a  beautiful  bluish  white  texture  shading  into  yellow  at  the 
cervical  margin. 

Pituitary  teeth  are  short  or  long,  not  so  bell-shaped,  more 
or  less  square-shaped  anteriors  are  the  rule,  yellowish  gray  in 
color. 

Adrenal  or  so-called  adrenal  teeth  are  small  bell-shaped 
organs  rapidly  yielding  to  attritional  wear,  occlusal  surfaces 
show  reddish  stains,  they  resist  decay  remarkably  well,  are 
yellowish  white  in  color,  quite  yellow  at  the  cervical  margin. 
Erosion  of  teeth  at  cervical  portions  is,  to  my  mind,  an  adrenal 
phenomenon  and  manifests  itself  in  many  cases  which  are  poten- 
tially neoplasmic.  The  same  is  true  of  teeth  which  seem  to 
possess  an  inherent  principle  of  immunity. 

Thymic  teeth  may  be  thyroidal  or  pituitary  in  character 
with  the  addition  of  scalloped,  fan-shaped  occlusal  or  incisal 
surfaces.  They  are  very  translucent  and  of  a  milky  white  or 
bluish  white  color. 

^lay  we  not  conclude  from  all  the  foregoing  that: 

When  a  little  child  presents  himself  to  us  and  the  little 
one's  teeth  are  in  malrelation  to  one  another,  we  ought  to  know 
how  to  correct  this  situation  without  harnessing  this  little  mas- 
ticating apparatus  in  all  sorts  of  unspeakable  and  distressing 
appliances,  furthermore,  we  ought  to  realize  that  this  very  mal- 


3/6  CAST  GOLD  AND  PORCELAIN  INLAYS 

relation  of  the  teetli  is  an  expression  of  a  constitutional  state  to 
be  ministered  to,  not  by  irritating  the  structures  in  the  mouth, 
but  by  gently  recalling  to  its  proper  sphere  of  activity  and 
supervision,  the  delinquent  part  of  the  mechanism,  the  tempo- 
rary aberration  of  which  caused  the  malrelation — a  thymopitu- 
itary  state. 

When  a  little  one  whose  teetli  decay  readily,  despite  all 
attention  to  hygiene,  presents  himself  to  us  for  our  attention 
and  aid,  we  should  so  minister  to  the  potential  man  or  woman 
in  it  as  to  recall  to  its  proper  sphere  of  activity  and  supervision, 
the  delinquent  part  of  the  mechanism,  the  temporary  aberration 
of  which  caused  the  dystrophy — a  thymothyroidal  state. 

AVhen  a  little  patient  whose  posterior  teeth  are  in  malrela- 
tion and  show  reddish  stains  on  the  occlusal  surfaces,  presents 
himself  to  us  for  attention,  we  should  be  able  to  recognize  an 
expression  of  a  thymopituitoadrenal  stress  and  so  minister  to 
the  little  one  as  to  recall  to  their  proper  sphere  of  activity  and 
supervision  the  delinquent  parts  of  the  mechanism,  the  tem- 
porary aberration  of  which  caused  the  dystrophy. 

When  a  little  patient  whose  teeth  in  the  premaxillary  region 
of  the  maxilla?  are  in  malrelation  presents  himself,  we  should 
recognize  this  as  aprenatal  pituitary  state  and  so  minister  to 
the  little  one  as  to  recall  into  proper  sphere  of  activity  and 
supervision,  the  delinquent  part  of  the  mechanism  responsible 
for  the  particular  expression. 

AYhen  a  little  patient  whose  lower  anterior  teetli  are  in  mal- 
relation, presents  himself,  we  should  recognize  this  as  a  post- 
natal pituitary  state  and  so  minister  to  the  little  one  as  to  recall 
to  harmonious  interplay  the  delinquent  part  of  the  mechanism, 
answerable  for  the  particular  expression. 

A  little  child  who  presents  himself  with  his  upper  laterals 
in  torsion,  is  possessed  of  some  gonadial  disbalance,  indicating, 
perhaps,  a  senile  gonadial  apparatus,  a  prenatal  pituitogonadial 
state  and  should  be  so  treated  as  to  recall,  if  possible,  to  proper 
sphere  of  activity  and  supervision,  that  part  of  the  mechanism, 
answerable  for  the  particular  expression. 

These  few  paragraphs  may  be  summed  up  in  the  following 
sentences : 

First,  dentition  as  to  time,  is  a  thymopituitary  function. 


KXIHHMMXOIKIXTIA  377 

Second,  dentition  as  to  position,  is  a  thymopituitary  and 
gonado-pituitary  function. 

Third,  dentition  as  to  quality  is  a  thyropituitary  function. 

Fourth,  dentition  as  to  resistance  is  a  thyroadrenal  func- 
tion. 

It  follows  from  this  that  the  first  permanent  molar  erupts 
in  normal  position  in  the  upper  arch  when  the  thymothyroidal 
apparatus  is  in  balance  and  when  there  is  no  prenatal  pituitary 
disturbance. 

It  erupts  in  normal  position  in  the  lower  arch  when  the 
thymothyroidal  apparatus  is  in  balance  and  when  there  is  no 
postnatal  pituitary  disturbance  before  six  years  of  age.  The 
above  holds  true  in  sequence  mentioned  for  the  upper  and  lower 
temporary  set  of  teeth. 

The  bicuspids  and  second  permanent  molars  and  cuspids 
are  most  often  in  malrelation  in  females,  because  they  erupt 
at  a  time  of  or  immediately  after  puberty  or  at  a  period  when 
the  pituitary  is  called  upon  to  adjust  itself  to  and  to  interplay 
with  the  awakened  gonadial  apparatus,  a  critical  time  in  the 
life  of  a  female  individual.  The  same  holds  true  in  a  male  per- 
son but  to  a  lesser  degree. 

The  torsion  of  the  permanent  laterals  indicates  an  anomaly 
of  the  uterus  as  to  position  or  some  ovarian  difficulty  in  the 
IV male  and  some  testicular  disturbance  in  the  male.  When  the 
torsion  is  very  decided  in  the  latter,  one  may  safely  assume  the 
presence  of  a  varicocele  in  the  patient. 

If  the  permanent  cuspids  are  forced  out  of  position  by 
apparent  lack  of  space,  they  point  in  females  to  ovarian  dis- 
turbances such  as  cysts,  fibroids,  etc.  In  males  they  are  an 
indication  of  recurrent  obscure  pains  in  the  lower  abdominal 
region  with  sensitive  areas  in  the  region  of  the  groins. 

If  these  cuspids  are  markedly  prehensile  in  formation,  they 
indicate  an  abundance  of  the  sexual  urge  as  mentioned  in  a 
previous  chapter  of  the  book. 

Individuals  whose  teeth  suffer  from  erosion  at  the  cervical 
margins  and  upon  the  labial  surfaces  and  which  present  an 
enamel  surface  which  is  highly  polished  and  of  a  greenish  white 
hue  bid  fair  to  be  candidates  for  neoplasms,  particularly  so 
when  red-haired. 


378  CAST  GOLD  AXD  PORCELAIX  INLAYS 

The  spacing  of  the  anterior  upper  teeth  is  a  pituitary  sig- 
nature and  often  tells  a  story  of  headaches,  constipation,  and 
other  gastric  disturbances. 

Teeth,  which  have  undergone  marked  change  in  macro- 
scopic appearance  due  to  attrition,  invariably  tell,  in  dark  peo- 
ple, a  story  of  freedom  from  infectious  diseases,  outside  of 
perhaps  measles  and  diphtheria  or  whooping  cough,  but  also 
point  to  the  predisposition  of  the  person  to  disturbances  of  a 
circulatory  nature  and  afflictions  of  the  lower  portions  of  the 
large  intestines. 

We  see  cases  of  mature  age  which  present  teeth  of  marked 
youthful  appearance.  "We  call  them  thymic  teeth  and  they  tell 
a  story  of  a  pituitary  and  gonadial  battle  against  a  powerfully 
entrenched  thymus,  resulting  in  a  compromise,  definitely  ex- 
pressed in  an  occlusal  relation  between  upper  and  lower  teeth 
which  permits  of  the  virtual  perpetuation  of  the  incisal  and 
occlusal  surfaces  characteristic  of  children's  teeth. 

I  am  convinced  that  a  deep  study  of  the  endocrines  and  a 
careful  therapeutic  application  of  them,  would,  to  a  great  ex- 
tent, if  not  altogether,  eliminate  the  endless  dystrophies  mani- 
festing themselves  in  the  oral  cavity;  and  thus  obviate  the  call 
for  a  great  number  of  tedious,  and  for  patients,  very  painful 
operations. 

I  appreciate  the  fact  that  many  will  read  this  chapter  with 
great  skepticism,  and  I  can  readily  understand  why  this  will 
be  so;  but  I  would  ask  these  readers  to  abide  in  faith  and 
read  some  of  the  books  to  be  recommended  and  then  carefully 
observe  their  patients,  question  them  at  length  and  so  learn 
from  their  own  daily  practice  to  understand  the  wonderful  in- 
terdependence which  exists  between  the  endocrines  and  the  den- 
tal apparatus  and  how  perfectly  they  express  themselves  in  the 
size,  texture,  quality,  and  position  of  the  teeth  and  their  envi- 
ronment. 

The  Creative  Force  at  Work 

In  the  accompanying  diagram  (Fig.  372)  two  triangles  are 
seen  superimposed  one  upon  the  other,  making  a  six-pointed 
star — the  Protector  of  David.  It  represents  the  conception  I 


KxnoriMXonoxTiA  .><!) 

have  of  the  I'niversal  Spirit  or  Mind  or  Soul  working  upon 
itself  and  expanding  in  consciousness  from  within  outward,  so 
that  it  begins  to  manifest  itself  in  various  ways  on  different 
planes  (creation). 

The  fact  that  these  triangles  are  so  placed  that  one  pre- 
sents with  its  apex  downward  and  the  other  with  the  apex  up- 
ward, will  mean  much  to  those  who  have  studied  occultism  and 
are  familiar  with  the  literature  on  symbolism. 


Fig.  372. 


We  see  here  the  large  .4  in  the  center  of  the  illustration. 
In  the  apical  portion  of  the  A  we  see  an  S  to  represent  the  Sun, 
the  energizer,  the  father,  he,  who  with  his  warmth,  animates  the 
Universe.  Directly  above,  we  see  the  point  of  the  star  marked 
PP  representing  the  pituitary  beneath  which  rests  the  pineal. 
Within  this  point  of  the  star,  the  M  represents  the  Moon  with 
its  psychic  significance  to  man. 


380  CAST  GOLD  AXD  PORCE.LA1X  INLAYS 

The  point  on  the  upper  left  marked  T  represents  the  thy- 
roid and  the  R  within  it  stands  for  the  restless,  ever-moving 
atmosphere. 

The  point  on  the  right,  also  marked  T  represents  the  thy- 
mus  or  youth  or  beginning  of  man.  The  V  within  this  point 
represents  the  vegetable  kingdom,  even  as  the  R  in  the  opposite 
point  represents  the  mineral  kingdom  with  its  finely-divided 
silicious  and  other  mineral  particles  floating  in  the  ether.  This 
F  representing  the  flowers  and  trees  and  leaves  upon  the  trees 
is  symbolic  of  ever-recurring  youth. 

The  two  points  below,  the  right  and  left  A  represent  the 
adrenal  bodies  or  energy  made  manifest  on  the  human  plane. 
The  W's  within  these  points  represent  the  waters  of  the  earth. 

And  finally,  the  point  below  marked  G  for  gonads,  express- 
ing immortality  on  the  procreative  plane.  The  E  within  this 
point  represents  earth  or  the  place  where  man  must  reach  a 
certain  stage  in  his  unfoldment  in  order  to  be  worthy  of  his 
Creator. 

Please  note  the  number  of  intercommunicating  lines  along 
which  impulses  or  hormones  or  whatever  we  may  choose  to  call 
them  may  travel. 

If  we  now  look  upon  the  large  central  A  as  the  heart  of 
man,  we  shall  have  a  picture  of  him  as  the  microcosm  within 
the  Universe  and  we  may  note  how  the  adrenal,  the  pituitary, 
the  pineal,  the  thyroid,  the  thymus,  and  the  gonads  all  have 
their  heart  valency  and  how  conversely  the  heart  presents  its 
radiant  impulses  impartially  to  all  of  them. 

The  vast  influence  of  these  glands  may  be  further  graph- 
ically illustrated  by  lines  or  arrows  going  from  the  six  points 
of  the  star  to  all  parts  of  the  body.  Such  as  skin,  hair,  teeth, 
muscles,  ligaments,  lungs,  liver,  bowels,  eyes,  ears,  nose,  throat, 
that  is,  pharynx,  larynx,  tonsils,  etc. 

The  network  is  so  vast  and  the  interdependence  so  inti- 
mate that  it  would  require  a  volume  of  considerable  size  to 
cover  the  subject. 

I  want  to  again  express  my  sincere  obligation  to  those  who 
before  me  have  worked  in  this  field,  and  my  keen  appreciation 
of  their  efforts.  If  I  have  omitted  giving  any  one  their  due 


EXDOCRIXODOXTIA  381 

credit  for  any  quotation  or  illustration,  I  herewith  acknowledge 
my  debt. 

To  all  who  would  delve  more  deeply  into  the  various  sub- 
jects treated,  I  would  earnestly  recommend  the  books  enumer- 
ated below. 


References 

BriLDixc  Ilr.MAX  INTELLIGENCE.    By  Arnold  Loraml,  M.D.,  1917. 

COSMIC  CONSCIOUSNESS.  By  AH  Nemand,  Advanced  Thought  Publishing  Co., 
Chicago. 

COSMIC  CONSCIOUSNESS.    By  Richard  Morris  Bucke,  Innes  &  Son,  Philadelphia,  1905. 

INTERNAL  SECRETIONS  AND  THE  DUCTLESS  GLANDS.  By  Swale  Vincent,  M.D.,  D.Sc., 
published  by  Edward  Arnold,  London,  1912. 

INTERNAL  SECRETORY  ORGANS.     By  Biedl,  published  by  Wm.  Wood  &  Co.,  1918. 

HERMENEUTIC  INTERPRETATION  OF  THE  ORIGIN  OF  THE  SOCIAL  STATE  OF  MAN.  By 
Fabre  D 'Olivet,  1768-1828,  (translated  into  English  by  Nayan  Louise  Red- 
field,  1915),  published  by  G.  P.  Putnam's  Sons,  New  York  City. 

LEHRBUCH  DKR  ORGANOTHERAPY.  By  Drs.  Wagner  Van  Jauregg,  of  Vienna,  and  Gus- 
tav  Bayer,  of  Innsbruck,  published  by  George  Thieme,  Leipzig,  1914. 

LIBRARY  OF  VALUABLE  INFORMATION.     D.  Appleton  &  Co.,  New  York  City. 

THE  STORY  OF  EXTINCT  CIVILIZATION  OF  THE  EARTH.     By  Robert  E.  Anderson, 

M.A.,  F.A.S.,  1903-1913. 

THE  STORY  or  PRIMITIVE  MAN.    By  Edward  Clodd,  1895-1913. 
THE  STORY  OF  THE  LIVING  MACHINE.    By  H.  \Y.  Conn,  1899-1913. 
THE  STORY  OF  THE  MIND.     By  James  Mark  Baldwin,  1902-1913. 

OLD  AGE  DEFERRED.     By  Arnold  Lorand,  M.D.,  published  by  F.  A.  Davis  Co.,  1913. 

PRINCIPLES  OF  LIGHT  AND  COLOR.  By  Edwin  D.  Babitt,  published  by  Babitt  &  Co., 
New  York  City,  1878. 

Six  THOUSAND  YEARS  OF  HISTORY.  By  Edgar  Sanderson,  A.M.;  John  Porter  Lam- 
berton,  A.M.;  Charles  Morris,  A.M.;  and  others;  published  by  Thomas 
Nolan,  Philadelphia,  1908. 

THE  BRAIN.  By  Emanuel  Swedenborg,  vols.  i  and  ii,  published  by  American  Sweden- 
borg  Printing  and  Pub.  Soc.,  New  York  City. 

THE  ECONOMY  OF  THE  ANIMAL  KINGDOM.  By  Emanuel  Swedenborg,  vols.  i  and  ii, 
published  by  American  Swedenborg  Printing  and  Pub.  Soc.,  New  York  City. 

THE  SOUL  OR  RATIONAL  PSYCHOLOGY.  By  Emanuel  Swedenborg,  published  by  Ameri- 
can Swedenborg  Printing  and  Pub.  Co.,  New  York  City. 

THE  CROSS  OF  THE  MAGI.  By  Frank  C.  Higgins,  F.R.N.S.,  published  by  Roger 
Brothers,  New  York  City,  1912. 

THE  ENDOCRINE  ORGANS.  By  E.  A.  Schafer,  LL.D.,  D.Se.,  M.D.,  F.R.S.,  published 
by  Longmans,  Greene  &  Co-,  New  York  City,  1916. 

THE  INTERNAL  SECRETIONS.  By  E.  Gley,  M.D.,  (translated  by  Dr.  Maurice  Fish- 
berg),  published  by  Paul  B.  Hoeber. 

THE  NEW  STANDARD  ENCYCLOPEDIA.     Funk  &  Wagnalls  Co.,  New  York  City. 

THE  THYROID  GLAND.  By  Robert  MCCARRISON,  M.D.,  D.Sc.,  F.R.C.P.,  published  by 
Win.  Wood  &  Co.,  New  York  City,  1917. 


382  CAST  GOLD  AND  PORCELAIN  INLAYS 

THE  PRACTITIONER.     SPECIAL  NUMBER  ox  THE  INTERNAL  SKCRETIONS.     Published  by 
"The  Practitioner,"  Ltd.,  London. 

January,  1915 

THE  THEORY  OF  INTERNAL  SECRETION:  ITS  HISTORY  AND  DEVELOPMENT.     By  E. 

Gley,  M.D.,  LL.D. 

THE  PHYSIOLOGY  OF  THE  THYROID  GLAND.     By  H.  H.  Dale,  M.A.,  M.D.,  F.E.S. 
THYROID  INSUFFICIENCY.     By  Dr.  E.  Hertoghe. 
ENDEMIC  GOITRE.     By  Major  Eobert  McCarrison,  M.D.,  F.R.C.P. 
EXOPHTHALMIC  GOITRE.     By  Leonard  Williams,  M.D.,  M.R.C.P- 
THE  PARATHYROID  GLANDS.     By  Arthur  F.  Hertz,  M.A.,  F.R.C.P. 
THE  PHYSIOLOGY  OF  THE  CHROMAFFIN  SYSTEM-    By  D.  Noel  Paton,  M.D.,  B.Sc., 

F.R.S. 

THE  ADRENAL  GLANDS.    By  T.  R.  Elliott,  M.D.,  F.R.S. 
PLURIGLANDULAR  INSUFFICIENCY,  ITS  INCIDENCE  AND  TREATMENT.    By  Henry  R. 

Harrower,  M.D. 
THE  FUNCTIONS  OF  THE  PITUITARY  BODY.    By  Swale  Vincent,  M.D.,  D.Sc.,  F.R-S. 

Edin.),  F.R.S.   (Can.). 

February,  1915 

THE  THEORY  OF  THE  INTERNAL  SECRETIONS.    By  Charles  E.  de  M.  Sajous.  M.D., 

LL.D. 

THYROID  INSUFFICIENCY.     By  Leopold-Levi,  M.D. 
THE  PANCREAS.     By  Carl  von  Noorden,  M.D. 
THE  INTERNAL  SECRETIONS  OF  THE  ALIMENTARY  CANAL.    By  W.  Langdon  Brown, 

M.A.,  F.R.C.P. 
THE  USE  OF  HORMONES  IN  MEDICINE.     By  Geo.  R.  Murray,  M.A.,  M.D.,  D.C.L. 

F.R-C.P. 
THE  USE  OF  HORMONES   IN  CHIDREN  's  DISEASES.     By   Herbert  Ewan  Waller, 

M.R.,  C.S.,  L.R.,  C.P. 
THE  USE  OF  HORMONES  IN  GYNECOLOGICAL  AND  OBSTETRICIAL  DISORDERS.    By  W. 

Blair  Bell,  B.S.,  M.D. 
HORMONES  IN  RELATION  TO  DISEASES  OF  THE  SKIN.    By  J.  M.  H.  Macleod,  M.D., 

M.R.C.P. 

INTERNAL  SECRETIONS  AND  THE  PSYCHOSES.    By  Thee.  B.  Hyslop,  M.D.,  F.R.S.E. 
THYROID  INSUFFICIENCY  IN  GENERAL  PRACTICE.    By  J.  Parlaue  Granger,  F.R.C.S. 
THE  WORKS  OF  PLATO.     Nottingham  Society  Edition. 

THE  WORKS  OF  THOMAS  TROWARD.     Goodyear  Book  Concern,  New  York  City. 
THEORY  AND  PRACTICE  OF  THYROID  THERAPY.    By  Herbert  Ewan  Waller,  M.D.,  D.Sc., 

L.R.,  C.P.,  published  by  Wm.  Wood  &  Co.,  1911. 

VAGOTONIA.     By  Eppinger  and  Hess,  monograph  series  No.  20,  published  by  Nervous 
and  Mental  Diseases  Publishing  Co.,  1915. 


INDEX 


Absorption,   of   light,  308 

Acid   cup   for   hydrofluoric    acid,   210 

Action,  coordinate,  mental  and  physical, 

43 
Active  reciprocal  functions  of  the  teeth, 

general,  58 
special,  59 
Adrenal   bodies,  363 
Adrenal   teeth,   375 
Adrenodont,  373 
Adrenodontia,    371 
Adrenotrop,  365 
A  Citation,    period    of,    in    alloying    gold 

and  platinum,   185 
Alarm     clock     attached     to     investment 

mixer,  168,  169 

Alimentary   functions,   of   the    teeth,    60 
Allopathic  thought,  366 
Alloying  gold  and  platinum,  method  of, 

183 
Alterative   factor   in   cavity  preparation, 

71 

Alumina,  composition  of,  163 
Amalgam  die,  making  of  the,  148 

use   of  in  making  porcelain  insert, 

295 

fillings,  poorly  executed,  as  a  cause  of 
multilated  occlusal  surfaces, 
236 

Amber-coJored  glasses,  184 
Amorphous  silicon,  160 
Anatomic  articulator,  246 
Anatomy,  tooth,  knowledge  of,  necessary 

to  inlay  worker,  152 
Angle  of  incidence  in  reflection  of  light, 

305 

Angles  of  bicuspids,  68 
of  cuspids,   67 
of  incisor  teeth,  65 
of  molars,  68 

Anterior  teeth,  cavity  tray  for,  144 
of   upper   jaw,    stress   index    for,    115 
splinting  of,  222 
Articulator,  anatomic,  246 
Asbestos,  ground,  and  water  paste,  295 
Attrition,   a  cause   of   mutilation   of   oc- 
clusal surface,  236 
causes  of,  242 
definition   of,   242 
effects  of,  244 
teeth  worn  down  by,  101 
types  of,  265 


Auditory  sense,  26 
Augmentation,  362 
Automatic   mixer,   167,   168,   170 
Automatic  wax  warmer,   131,  132 

B 

Badger  brush,   169 

Baly,  310 

Bicuspid    presenting    a    complex    cavitv. 

113 
presenting   a    compound   disto-occlusal 

cavity,  83 

presenting  a  mesio-disto-occlusal  cavi- 
ty, 87,  91,  111 
presenting  a  mesio-occlusal  cavity,  85, 

89 
presenting  a  mesio-occluso-distal  cavi- 

ty,  344 

presenting   simple    occlusal    cavity,   81 
Bicuspids,  angles  of,  68 
surfaces  of,  68 
stress  index   for,  81-115 
Bleaching  of  wax,  127 
Brass  cups,  350 
Brewster,  Sir  David,  303 
Brute  Force,   37 
Buecal  cavity  in  a  molar,  99 
Bulk  to   be  added  to   teeth  worn  down 

by  attrition,  244 

Bunsen   burner   for   drying  mold,   174 
Burning  out  the  wax  model,  173 
Burnishers,  use  of,  in  placing  the  inlay, 

214 
Burnishing  of  margins  after  cementation 

of  inlay,  217 

Burnishing  the  wax  inlay,  154 
Byram,   323,  325 

C 
Calcium,  composifion  of,  162 

metabolism,  366 
Carbonic  acid  gas,  356 
Cardioauxiliarv    functions   of   the   teeth, 

58 

Carving  of  molar  crown,  257 
Carving    the    wax    inlay    by    the    direct 

method,  131 

Cast  bases,  gold  for,  186 
Cast  gold  complement  for  a  tooth  pre- 
senting    a     mesio-disto-occlusal 
cavity,    120 

Cast  gold  inlay,  62  (See  also  Gold  inlays) 
and  porcelain  for  restoration  of  frac- 
tured lower  lateral,  279 


383 


384 


INDEX 


Cast  gold— Cont'd. 

and  porcelain  inlay  for  compound  dis- 
to-occlusal  cavity  in  biscuspid, 
83 

for  mesio-occlusal  cavity  in  bi- 
cuspid, 89 

and    porcelain    insert    for   mesio-labio- 

linguo-incisal  deficiency,  289 
in  lower  cuspid,  281,  283 
method  of  making,  286,  287 

and  synthetic  porcelain  for  mesio-dis- 
to-labio-incisal  deficiency  in  a 
central,  291 

restoration  of  lateral  by  means  of, 
273,  285 

cementation  of,  213,  215 

cleansing  of,   before   cementation,   216 

contraindication,   269 

defined,  63 

extensive  restorations  of  occlusal  bal- 
ance by  means  of,  236 

for  complex  cavity  in  a  bicuspid,  113 
in  a  molar,  105 

for  deficiency  of  occlusal  third  of  mo- 
lar, 103 

for  a  disto-buccal  cavity  in  a  molar, 
97 

for  disto-occlusal  cavity  in  a  molar,  97 

for  disto-occluso-buccal  cavity  in  a 
molar,  107 

for  labio-  or  bucco-occlusal  cavity  in 
a  molar,  93 

for  mesio-disto-occlusal  cavity  in  a  bi- 
cuspid, 87,  91,  111 

for  mesio-disto-occlusal  cavity  and 
buccal  cavity  in  a  molar,  99 

for  mesio-disto-occluso-palatal  cavity 
in  a  molar,  109 

for  mesio-occlusal  cavity  in  bicuspid, 
85 

for  simple  occlusal  cavity  in  bicuspid, 
81 

formulae  for,  185 

indirect  method  of  making,   139 

mesio-disto-occlusal,  120 

placing  of,   in   cavity,   213 

polishing   the,   213 

splinting  of  loose  teeth  by  means  of, 
218,  235 

seating  the,   217 

Cast  gold  inlays  for  teeth  worn  down 
by  attrition,  101 

for    lingual   surfaces    of    teeth    to    be 

splinted,  231 

Casting,  cleansing  of  the,  in  hydrofluoric 
acid  and  sodium  bicarbonate, 
209 

machines,  test  for,  205 

of  metal  under  pressure,  197 

of  molten  metal  into  the  mold,  ma- 
chines employed  in,  187 


Casting — Cont  M. 

of  molten  metal  into  the  mold,  178. 
Cavities  classified,   74 
Cavity,  buccal,  in  a  molar,  99 
cervical,  in  a  molar,  341 
cervical  proximal,  in  a  lateral,  341 
complex,   in   a   bicuspid,   113 

in   a   molar,   105 
compound  disto-occlusal,  in  a  bicuspid, 

83 

disto-buccal,  in  a  molar,  97 
disto-labial,  in  a  central,  338 
disto-occlusal,  in  a  molar,  95,  97,  342, 

343 

disto-occluso-buccal,   in   molar,   107 
labio-disto-lingual,  in  a  lateral,  339 
labio-occlusal,  in  a   molar,  342 
labio-    or    bucco-occlusal,    in    a    molar, 

93 

linguo-mesial,  in  a  lateral,  340 
mesio-    and    disto-proximal,    in    a   cen- 
tral,  293 

mesio-disto-occlusal,  120 
in  a  bicuspid,   87,   91,   111 
in  a  molar,  99,  343 
mesio-disto-occluso-palatal,  in  a  molar, 

109 
mesio-occlusal,  in  a  bicuspid,  85,  89 

in  a  molar,  343 

mesio-occluso-distal,  in  a  bicuspid,  344 
preparation,  65,   76 

for  porcelain  inlay,  328 
mesio-disto-occlusal,  121 
of  floor  of  a,  114 

selection  or  election  of  a  case  present- 
ing a,  64 

simple  occlusal,  in  bicuspid,  81 
Cement,  crystallization  of,  217 

mixing  of,   216 

Cementation  of  the  inlay,  213,  215 
Central,    fractured,    restoration    of,    271 
left   upper,    presenting    a    mesio-disto- 
Jabio-incisal       deficiency,       cast 
gold  inlay  and  synthetic  porce- 
lain  insert   for,   291 
right  upper,  presenting  an  eroded  and 
pitted   labial   surface,   a  mesio- 
and    disto-proximal    cavity,    293 
presenting    mesio-labio-linguo-incisal 

deficiency,  289 
Central   nervous    system,   injury   to,    due 

to  jacket  crowns,  293 
Centrifugal   casting   machines,    188,    189 

force,   188,  189 
Cervical  cavity  in  a  molar,  341 
Cervical  proximal  cavity  in  a  lateral,  341 
Charcoal  block  with  depression  to  act  as 

a  crucible,  183 

Chart  of  prismatic  colors,  316,  317 
Chisels  for  tooth  structure  cutting,  72 


[NDBX 


385 


Chromatic  aberration,  304 
Church,  A.  II.,  :ili' 
Clamp  and  rubber  dam,   7.". 
Classification    of    functions    of   teeth,    58 
» Me;i  lining  of  the  casting  in   hydrofluoric 
acid  and  in  a  sodium  bicarbon- 
ate  bath,   209 
Cleansing    the    cavity    before    cementing 

the   inlay,  216 

Cleveland    Dental    casting    machine,    198 
Cold    flask,    as    a    preventive    of    distor- 
tion of  the  mold,  180 
Color  in  relation  to  the  porcelain  inlay, 

300 

intermediate,    '.\\~> 

of    gold    when    silicates    are   used,    287 
of  porcelain,  3.14 
phenomena  of,  302 
Colors,   complementary,    318,   319 
harmony  of,  317 
primary,    312 
prismatic,    317 
rainbow,   317 
secondary.   :;i:: 

tertiary.    -;'  1 

Combining  weight  of  gold,   182 
Compensatory     dynamics    of    the    endo- 

crines,  365 

Complementary  colors,  318,  319 
Complex  cavity,  defined,  75 
in  a  bicuspid,   113 
in   a   molar,   105 
showing  planes,  78 
Composition   of  wax,  127 
Compound   cavity    defined,    74 
Compound   cavities,   preparation   of,   for 

porcelain,   329 

Compound  disto -occlusal  cavity  in  bicus- 
pid, 83 

Compound,   formula   for,   164 
investment,   158 
refractory,  158 

Compound-carrying  trays,  method  of  tak- 
ing impression  with,  146 
Construction  of  splint  for  restoration  of 
occlusal  balance  in  cases  of  at- 
trition, 245 
Contact  lines,  215 
points,  215 
proximal,    determination    of,    between 

molars,    258 
Coordinate  action,   mental  and  physical, 

42 

Coordinate  mental  efforts,  factors  induc- 
ing,  24 
Copper  alloy,  use  of,  in  making  amalgam 

die,  148 

Copper  band  for  making  wax  inlay,  136 
Cosmetic   functions   of   the  teeth,   58 


Cosmetic   reasons   for  not  using  gold  for 

the  inlay,   269 
Creation,  47,  379 
Creative  force,  48 
Crown,    molar,    carving   of,   257 
Crystallization    of    amalgam    die,     151 
of  cement,  217 
of  the  mold,  171 

Cuspid,  lower,  restored  by  cast  gold  in- 
lay and  porcelain  insert,  281, 
283 

presenting  cavity,  297 
upper    right,    presenting    a    prehenso- 
labio-linguo-mesial        deficient- v. 
399 

Cuspids,  angles  of,  67 
surfaces  of,  67 

D 

David,  protector  of,  379 

Defensive  functions  of  the  teeth,  58 

Dentistry,  50 

Dentition,  as  to  position,  a  thymopitui- 
tary  and  gonadopituitary  func- 
tion, 377 

as    to    quality,   a   thyropituitary   func- 
tion,   377 

as  to  resistance,  a  thyroadrenal  func- 
tion, 377 

as  to  time,  a  thymopituitary  function, 
376 

Depth  for  cavity,  295 

Developmental  functions  of  the  teeth, 
58 

Die,  amalgam,  making  of  the,  148 
for  procedure  by  indirect  method,  139 

Direct  method,  advantages  of,  140 

Direct  method  of  making  and  carving 
the  wax  inlay,  131 

Direct  pressure  machine,  200 

Diseases,  endocrine  glands  in  relation  to, 
366 

Di?to-buccal  cavity  in  an  upper  molar, 
97 

Disto-occlusal  cavity  in  a  molar,  95,  97, 
342,  343 

Disto-occlusal  cavity   tray,  144 

Disto-occluso-buccal  cavity  in  a  molar, 
107 

Distorted  mold,  due  to  use  of  hot  flask, 
179 

Drying  out   the   mold,   173 

Ductless   glands,   359 

E 

Elastic     membrane     surrounding     teeth, 

function  of,  54 

Elasticity   of  suspension   ligament,   118 
Klection  of  the  case  presenting  a  cavity, 

64 


1NDKX 


Elgin     vacuum     casting     machine     and 

flasks,  192 

Enamel  seat  of  inlay,  77 
Endocrine  glands,  in  relation  to  diseases, 
366 

gonads,    364 

pineal,  363 

pituitary,    363 

thyroid,"  363 

thymus,    363 

suprarenal   capsules,   363 
Endocrines,  362 

compensatory  dynamics  of,  365 
Endocrinodontia,  359 
Endocrinology,  study  of,  362 
Errors  and  accidents  primary  causes  of 

human  ills,  49 

Ether,   elastic,   in   relation   to   light,   303 
Eucalyptol  compound,  235 
Evolution,  48 

Excess  metal,  removal  of,  213 
Exercise  of  tissues  essential,  55 
Extirpated  pulp,  279 

Extirpation  of  pulp  in  large  restorations, 
276 

F 

Face,  normal,  measurements  for,  249,  255 
Feldspar,    323 

Fillings,    amalgam,    poorly    executed,    as 
causes  of  mutilation  of  occlusal 
surface,  236 
Flask,  special,  204 

Taggart,   204 

Floor  of  a  cavity,  preparation  of,  114 
Foil  matrix  for  porcelain  inlay,  making 

the,   333 
Formative   factor  in  cavity  preparation, 

71 

Formula  for  a  compound,  164 
Fractured   central,   restored   by  gold   in- 
lay   and    porcelain    or    the    sili- 
cates, 271 

Fractured   lower  lateral,   279 
Frail  teeth,  gold  for  inlays  in,  186 
Function  of  elastic  membrane  surround- 
ing teeth,  54 

Functions  of  the  teeth,  52 
active   reciprocal,   58 
general,  58 
special,  58 

passive  reciprocal,  58 
cosmetic,   58 
defensive,  58 
developmental,    58 
phonetic,    58 
Furnace,  Platcheck,  175 
Fusing  of  porcelain,  325 
Fusing  point  of  gold,   182 
of  platinum,  182 


Gases,  absorption  of  light  by,  .'!09 
Gauge    of    wire    for    supplemental    pins, 

79 

Gelatin  impression   of  a  model,   118 
General    active    reciprocal    functions    of 

the  teeth,  58 

Geometric  construction  of  molars,  257 
Geometric   landmarks   of   teeth,   65 
Gingivae,  condition  of,  in  cases  of  attri- 
tion. 243 

Glands,   ductless,   359 
Glass,  color  of,  311 
Glazbrook,    304 
Gold,  alloying  with  platinum,  183 

color   of,  287 

combining  weight  of,  182 

for  cast  bases,  186 

for  inlay  work,  182,  186 

for  saddles,  186 

fusing  point   of,   182 

inlay,  and  porcelain  or  the  silicates  in 

a   fractured  central,   271 
and   the   silicates    or   porcelain,    269 

and    silicate    cement    to    restore    frac- 
tured lateral,  275 
formulae  for,  185 

specific  gravity,  1821 

symbol,    182 
Gonadontia,  369 
Gonadotrop,    3(55 
Gonads,    .'!(!  1 
Graphite  flakes,  in  investment,  166 

paste,  233 

post,  229 
Grimaldi,  303 

Grinding   the   porcelain   matrix,    352 
Gum  tragacanth,   353 
Gypsum,  composition   of,   159 

H 

Harmony  of  colors,  317 

Healing   art,   49 

Health,  function   of  gums  and   teeth  in, 

52 

general,  should  be  looked  after  in 
cases  requiring  treatment  for 
loss  of  occlusal  balance,  242 

Hertz,    303 

High-fusing  porcelain,   324 
shrinkage   of,    326 

Hinged   trays   for   taking   impression   of 
cavities,   144 

Hook,  303 

Hormones,   definition   of,  362 

Hot  flask,  use  of,  in  casting,  gives  dis- 
torted mold,   180 

Hot  water  as  a   means  of  warming  wax, 
131 

Hue   of   colors,   311 


INDEX 


llutchinson  's   t  '('tli,  60 
HuyiM'iis.    ;;n:; 
II\  drodiloric    iu-i'l.    .V>7 
bath,    \^~> 

Hydrofluoric   acid,  cle:in>in;j  of  tin1  cast- 
ing   in,    I'11! i 
making    receptacle  for,  210 

lly-ienic   landmarks  of  the  teeth,  69 

Hygroscopic      characteristic     of     invest- 
ments, 165 

Hypnotics,    use   of.    iii    cases   of   attrition. 
245 


Ideal    of   a    task,   4<i 
Ideal   wax    tHr   inlay   work,  130 
Immune  areas  of  a  tooth,  69,  70 
Impression  of  the  cavity,  method  of  tak- 
ing,   for    procedure    by    indirect 
method.    1:59 
of  the  cavity,   method  of  taking,  with 

cumpound   trav>,    146 
trays    339,    344 

wax.   direct    method   of   taking,   131 
Incision,    60 

teeth   as  organs  of,    '<- 
Incisor    teeth,    angles    of,    63 

surfaces    of,    <i.~i 
Indirect    method   of   making  a  cast   gold 

inlay,    139 

disadvantages  of.  Ho 
.-election   of,   139 
Individual  volition,  48 
Inhibition,    .'Mil' 

Inhibitory   functions  of  the  teeth,  60 
Inlay,    cast   gold,   <>2    (x<  c   Cast  gold   in- 
lay ! 

cementation    of,    213,    31.', 
placing  in  cavity  for  cementation,  213 
polishing    the,    213 
porcelain,   (see  Porcelain  inlay) 
restorations,     poorly     executed,    inhibi- 
tory to  function  of  teeth,  55 
wax.  making  and  carving  of,  by  direct 

method,   131 
work,   r>2 

instruments   for  use  in,   73 
metals  for,  182 
wax   suitable   for,   129 
Inlays,    metallic,   iii1 

splinting  loose  teeth  by  means  of,  218, 

235 

Inside    of    the    tooth,    77 
Instruments  for  the  inlay  worker,  73 
Instruments    for   making    the   wax   inlav, 

137 

Internal    senvtion,    organs    of,    .",(12 
Investment   compound,   158 
Investment   mixer,    168,  170 
Investment  of  the   matrix   in  preparation 
•  f    pon-e'ain    in>ert.   295 


1 1  idio  platinum   threaded    p»-ts.   >i/.es    for 
various  teeth.  -77 


.lacket    crowns,    objections    to,   2!»3 
.Jiffy    cement    tube.    216 
Jiffy   tube,   286 
.Johnson,  Dr.,   3::i 

K 

Kaolin.   ::23 

Kaplan.  Dr.  I).  M..  3C.5 

Kipling,    4.") 


Labio  disto-lingual    cavitv    in    a    lateral, 

339 

Labio  -occlusal   cavity   in   a   molar.  •".  IL' 
Labio-     or     biicco  -occlusal     cavity,    in    a 

molar,  !»."• 

Landmarks   for   occlusal   carving,    152 
hygienic,  69 
of  teeth,   geometric,    ii."i 
Lateral,    cervical    proximal    cavitv    in    a, 

341 
fractured,   restored  by  gold  inlay  and 

silicat.'    cement.    -7~> 
labio-disto-lingual  cavity  in  a,  339 
linguo-mesial  cavity   in.  .'lln 
low:  r,  fractured  in  a  fall,  279 

restored  by  cast  gold  inlay  and  syn- 
thetic porcelain,  273 
Law   of   refraction,   306 
Le   Crone  casting  machine,   198 
Life,   in   the   abstract,  56 

in   the  concrete.    '>*'> 
Light,    absorption    of,    308 
phenomena   of,    302 
reflection,    305 
refraction,  306 
wave  theory  of,  303 
waves,   frequency  of,  310 
Lily-white,    '.'-7 
Lingual  surfaces  of  teeth  to  be  splinted. 

inlays  for,  231 

Linguo-mesial  cavity  in  a  lateral,  340 
Loose   teeth,    splinting   of,   by   means   of 

inlays,  218,  235 
Low-fusing  porce'ain,  324 

>hrinkage  of,  ::i>() 
Luminosity    of   color,   311 

M 

Machines  for  casting  of  the  molten  metal 

into    the    mold,    187 
Magnesium,    composition   of,    Ifi2 
Making  wax   inlay  by  direct  method.   1.".  1 
Malocclusion,  end-to-end,  ,-is  cause  of  at- 
trition,   21^ 

its    relation    to   proper    function   of  the 
teeth.    54 


388 


ixnnx 


Malrelation  of  teeth,  as  related  to  endo- 
crine glands,  375,  376 
puberty  in  relation  to,  377 
Margins,   burnishing   of,   after   cementa- 
tion,   217 

carving  of,  in   wax  inlay,   136 
of  the  cavity,  preparation  of,  76 
Mastication,  60 

teeth  as  organs  of,  52 
Materials  used   in   refractory   compound, 

159 

Matrix,   foil,   for  porcelain  inlay,   333 
for  porcelain  insert,  295 
in  position  upon  a  molar,  141 
making  wax  impression  with  a,  136 
metal,  making  of  porcelain  inlay  with- 
out,  337-357 
porcelain,  351 

Measurements  for  normal  face,  249,  255 
Mechanical  factor  in  cavity  preparation, 

71 

Melt,  making  the,  183 
Mental   efforts,   factors  inducing  coordi- 
nate, 24 
Mercury,  removal  of,  from  amalgam  die, 

150 

Mesio-   and   disto-proximal   cavity,  293 
Mesio-disto-labio-incisal    deficiency    in    a 
central,  cast  gold  inlay  and  syn- 
thetic  porcelain   insert   for,  291 
Mesio-disto-occlusal  cast  gold  inlay,   120 
Mesio-disto-occusal  cavity,  120 
preparation  of,   121,  124 
in  a  bicuspid.  87,  91,  111 
in  a  molar,  99,  343 
Mesio-disto-occluso-palatal     cavity    in     a 

molar,  109 

Mesio-labio-linguo-incisal  deficiency,  cast 
gold  inlay  and  porcelain  insert 
made  for,  289 

restored  by  cast  gold   inlay  and  syn- 
thetic porcelain,  285 
Mesio-occlusal  cavity,  85 
in  a  lower  molar,  343 
tray,  144 

Mesio-occluso-distal  cavity  in  a  bicuspid. 

344 
Metal,  casting  of,  under  pressure,  197 

castings  made  under  pressure,  187 

molten,  casting  into  the  mold,  178 

removal  of  excess,  213 
Metallic  inlays,  62 
Metals  for  inlay  worker,  182 

gold,  182 

platinum,  182 

Mineral  wax,  composition  of,   128 
Model,  splint  in  position  on,  247 
Models,  for  study  of  stress  index,  116 

necessary  for  extensive  restoration  of 
occlnsal  balance,  240 

study,  236 


Models— Cont'd. 

study  of,  in  articulatm ,  -!>' 
Molar  crown  divided   into  thirds,  -~n 
Mn!ar.    lower,    inesio occlusal   i-avitv   in   a, 
343 

presenting    a    cervical     cavity    in    the 
disto-labial  surface,  ?>41 

presenting  a  complex  cavity,  105 

presenting    a     deficiency     of     ocdusal 
third,  103 

presenting  a   disto-occlusal   cavity,  95, 
::-»!',  343 

presenting  a  disto-occ'usal   cavity   and 
a  disto-buccal  cavity,  97 

presenting  a  labio-occlusal  cavity,  342 

presenting    a    labio-    or    bucco-occlusal 
cavity,  93 

presenting    a    mesio-disto ocdusal    cav- 
ity. 343 

presenting    a    mesio-disto-occlusal    cav- 
ity and  a  bucca!  cavity.  !i;i 

presenting  a  mesio-disto-occluso-buccal 
cavity,   107 

presenting  a  mesio-disto-occluso-palatal 
cavity,   109 

reproduction  of,  in  gold,  260 
Molars,  angles  of,  68 

determination  of  proximal  contact  be- 
tween, 258 

Mold,  casting  the  molten  metal  into  the, 
178 

drying  out  of  the,  173 

temperature   of,   in   casting  of   molten 

metal,  178 
Molten  metal,  casting  into  the  mold,  178 

casting   of  the,   machines  employed   in 

187 

Moore,  Tom,  46 
Mouth,  ductless  glands  in  relation  to  the, 

359 
Myrica  Cerifera,  128 

N 
Naso-mental  line,  normal,  249,  '2^~> 

restoration  of,  249 
Xewton,  Sir  Isaac,  302 
Xit's,  Dr.,  337 
Nitrous    oxide    combined    with    city    L;US 

to  give  necessary  heat  tinits  in 

alloying,  183 

Xormal  face,  measurements  for,  249,  25.1 
Xormal   occlusion,  illustrated,   117 
Noyes,  7- 
\  yi nan,  Dr.,   216 

O 

Occluded   mode's   of   case   requiring    res- 
toration,  151 

Occluded   study   mode's,   237 
Ocdusal  balance,  definition  of,  239 

extensive    restoration    of,    by    means 
of  gold  inlays.   2:'.(> 


INDEX 


Occlusal  balance — ('out  M. 

preliminary    points   necessary   to   res- 
toration   of,    -l'i 
restoration  of,  view  of  case  showing. 

splint   to  restore,  I'l.", 
carving,     nifthoil     of     securing     land- 
marks   for,    152 

surface    of    wax    inlay,    method   of   ob- 
taining,   138 

surfaces,    illustrations   of,   263,   264 
view   of  case   showing  attrition,  253 
Occlusion,    normal,    illustrated    117 

traumatic.  :!»in 

Oceluso-disto-lingual  plane,  79 
Occluso-mcsio-luiccal    plane,    7!> 
On-inlay,  121 
Operative    factor   in    cavitv    preparation. 

71 

Optic    sense,    1' I 

Oral  conditions  in  cases  of  attrition,  243 
Osseous  system   out    of  harmony,  cause 

of  attrition.  I'll' 
Outside  of  the  tooth.  77 
Ovary  in  relation  to  incisors,  370 
Oxyphosphate.  melting  point  of,  .'!.'>  J 
Ozokerine,  129 
O/okerite.  128 


Paraffine,  composition  of,  128 

Parallel  rays  of  light,  305 

Paralleling  root    canals    of  teeth   to  be 

splinted,  218 
Parallelodrill,  218,   223 

reaming  out  two  root  canals  with,  224 
I'arallelometer,  218,  219 
Parathyroid  bodies,  363 
Partial   splints,   250 

Passive  reciprocal  functions  of  the  teeth, 
58 

cosmetic,  58 

defensive,  58 

developmental,  58 

phonetic,  58 

Pathologic  anatomy,  360 
Phenomena  of  light  and  color,  302 
Phonetic   functions  of  the  teeth,  58 
Piersol.   7i! 
Pin  vise,  use  of,  in  splinting  teeth  with 

inlays,    229 
Pineal  gland.  303 
Pins,  disadvantage  of,  71 

gaui:e   wire  for.   7!' 

preparation  of,   79 
Pituitary  body,  363 
Pituitary   teeth.   :;7."> 
Pituitodontia,  368 
Pitnitotrop,  364 
Planes  oi'  a    molar  cro\\  n,  i'." 


Planes  pret'eralde  to  ]<\it>  in  preparation, 

of   ca\  ity.    7!»    !' 

Plaster  model   of  teeth,   making  of,  147 
Plaster  of   Paris.    l.ljt 
Platcheck    furnace.    17:!.    17.1,    17H 
Platinum,  alloying  wjf),  <r0l, |,   l>;; 

comliining    \\ejght    of.    1>J 

foil    for    matii.x.    !'!».") 

for  inlay  \\ork,  182 

fusing   |  mint,   182 

>pecili<-    gravity.    182 

symbol,  182 

Polishing  of  cavitv   \\alls.    1  i'."i 
of  inlay.  i'i:: 
of  \\ax    inlay,   134 

Porcelain  and  cast  gold  inlay  for  res- 
toration of  fractured  lateral. 
879 

and  gold  inlays,  269 
applicalde     for    simple    cavities    only. 

328 

dental,  composition  of,  323 
fusing  of,  ."•!'.") 
high-fusing,  324,  325 
inlay.  V,.  :;±.' 

contraindications  to,  .'li'i' 

foil  matrix  for,  333 

for  complex  cavitv   in   a  bicuspid, 

113 

indications  for,  '.'•-- 
making  of,  without  use  of  a  metal 

matrix,  337,  357 

making  wax  impression  for,  336 
preparation  of  cavity  for,  328 
insert  and  cast  gold  inlay  for  mesio- 
labio-linguo-incisal  deficiency  in 
a  central,  289 
and  cast  gold  inlay  in  a  cuspid,  281, 

283    ' 
for  disto-occlusal  cavitv  in  a  molar, 

95 

taking  impression  for,  286,  295 
low  fusing,  324 
matrix,  351 

or  silicates,  and  gold  inlays  in  a  frac- 
tured central,  271 
replacing  facial  portions  with  a,  286 

Positional  symptomatic  functions  of  the 
teeth,  60 

Posterior  teeth,  loss  of,  as  a  cause  of 

attrition,    l'4L' 

Postnasai  pituitary  state,  376 
Posts,  iridio-platinnni.  si/.es  for  various 

teeth,  277 

rules  in  connection  with  use  of,  277 
Prehension,  60 

teeth  as  organs  of.  .">:.' 
Prehcnso-labio-linguo  mesial    deficiency, 

299 


390 


INDEX 


Preliminary  steps  before  beginning  a 
rase  of  extensive  restoration, 
236 

Prenatal  pituitary  state,  376 

Preparation   of   an   M.O.D.   cavity,   121 
of  a  cavity,  65,  76 
of  cavity  for  porcelain  inlay,  328 

Pressure  machines  in  casting,  191 
all  metal  castings  made  under,  187 
direction  of  application  of,  for  vari- 
ous cavities,  153 
effect  of,  on  teeth,  54 

Preston,  304 

Price,  Dr.,  350 

Price  's  stone  model,  355 

Primary  colors,  312 

Prismatic  colors,  317    ' 

Procreation,  364 

Properties  of  wax  required  for  inlay 
work,  129 

Protector  of  David,  379 

Proximal  contact  between  molars,  de- 
termination of,  258 

Puberty  in  relation  to  malrelatlon  of 
the  teeth,  377 

Pulp,  extirpation   of,  276 

Pyorrhea,  361 

E 

Radiation,  302 

Railroads  in  relation  to  life,  33 

Rainbow   colors,  317 

Rapid  heating,  guard  against,  in  dry- 
ing out  mold,  174 

Reading,  influence  of,  to  coordinate  ac- 
tion, mental  and  physical,  43 

Receptacle  for  hydrofluoric  acid,  mak- 
ing of,  210 

Reciprocal   functions   of   the   teeth,   ac- 
tive, 58 
passive,  58 

Reconstruction  of  molars  and  bicns- 
pids,  251 

Record  models,  236,  241,  249 

Reflection  of  light,  304 
angle  of  incidence,  305 
incident   ray,  305 

Refraction  of  light,  law  of,  306 

Refractive  index,  310 

Refractory  compound,  158 

investment  .of  splint  in,  250 

Removal  of  decay  in  preparation  of 
cavity,  125 

Resistance  pinion,  214 

Restoration,  extensive,  a  case  of,  267 
of  occlusal  balance,  case  showing,  254 
of  occlusal  balance  by  means  of  cast 
gold  inlays,  236 

Roach,  Dr.,  instruments  devised  by,  .'544 

Root  canals,  paralleling  of,  218 


liiibber  bowl  f.or  mixing,  l(i(i 
dam  and  clamp,  73 

dam,    use    of,    in    cementation    of    the 
cavity,  215 

S 

Saddles,  gold  for,  186 

Sandarac  for  varnishing  model,  1.12 

Sanford,  314 

Sealers,  73 

Schafer,    72 

Schcllenon,  310 

Schreier,   Dr.,   332 

Seating  the  inlay,  217 

Secondary  colors,  313 

Selection   of  case   presenting  a   cavitv 

64 

of  first  tooth  to  operate  upon  in   ex- 
tensive restorations  of  occlusal 
surfaces,  239 
of  proper  wax,  127 
Sense,  auditory,  26 
optic,  24 
tactile,  31 

Separating   tilted   teeth,   330,   331 
Sequence  of.  thought,  21 
Seymour  casting  machine,  198 
Shade  of  porcelain,  354 
Shock   to   a  tooth   under   stress   mastica- 
tion, 118 

Shrinkage  of  porcelain,  353 
Silex,  323 

and  water  paste,  295 
Silicate    cement    and    gold    inlay    to    re- 
store fractured  lateral,  275 
Silicate,  replacing  facial  portions  with, 

286 

Silicates  and  cast  gold  inlays,  269 
or  porcelain  and  gold  inlays  in  frac- 
tured central,  271 
Silicon,  composition  of,  160,   161 
Simple  cavity,  defined,  74 
Simple    occlusal    cavity    of    upper    first 

bicuspid,  81 

Simplex  casting  machine,  198 
Slide    for    carrying    compound,    making 

of,  339-344 

Sii ell's  law  of  refraction,  306,  307 
Sodium   bicarbonate   bath,    cleansing   of, 

casting  in,  209 
Solar  spectrum,  308 
Solbrig  machine,  199 
Spatula  for  mixing  cement,  216 

for   placing    and    holding   impression 

material,  338 
Specific  gravity  of  gold,  182 

of  platinum,  182 
Spectrum,  308 

Splint,    finished,    ready    to    be    inserted, 
232 


Splint    -ContM. 

for    restoration    of    occlusal    balance. 

247 
I'm-  restoration  of  occlusal  balance  in 

cases  of  alt  fit  ion,  !'}."> 
use  of.  in  cases  of  attrition  to  restore 

occlusal  balance.  iM.~> 
vulcanite.    L'ls 
Splinting  anterior  teeth.  222 

loose   teeth   l>v   means   of   inlavs,   218- 

i':;r. 

Sprue    win1,    insertion    of,    in    inlay,    l.~>4 

use  of.  124 
Steanne.  1' 1  1 

Sterilixation  of  the   cavity.   21.1.   21ti 
Stokes,  304 
Stress,    a    factor    in    restoring    occlusal 

balance.  lV.7 
index,  of  bicuspid,  lower,  83,  87,  89,  9 

upper.  SI.  So,  111,  113 
of  central,  lower,  271 

upper.   LVS'.I.  291.  293 
of  cuspid,  lower,  281,  283 

upper.   297.   299 
of   lateral,   lower,   273,   275,   279 

upper.   Us.""! 
of  lower  teeth.   1 1"> 
of  molar,  lower.  93.  95,  103,  107 

upper.   97,   99.    105,   109 
of  upper  teeth,  114 
Structural    sympotomatic    functions    of 

the  teeth,  60 
Study  models.  236 
Suction  machine   in   casting,  191 
Sulcus  reproduced  in  wax,  inlay,  77 
Supplemental  pins,  preparation  of,  79 
Suprarenal    capsules,   363 
Sure   Cast    machine.    l!'s 
Surfaces  of  bieuspi'i- 
of  cuspids.  (57 
of  incisor  t  eeth,  6.1 
Surgical    or    operative    factor    in    cavity 

preparat  ion,  7  1 

Susceptible  area   of  a  tooth,  69 
Suspension   ligament,  elasticity  of,   118 
Swage,  simple,   198 

Symptomatic  functions  of  the  teeth,  60 
Synthetic  porcelain  and  cast  gold  inlay 

in  restoration  of  lateral,  285 
and    cast    gold    inlay,    restoration    of 
lower  lateral  by  means  of,  273 
inlay  for  a  complex  cavity  in  a  bicus- 
pid, 113 
for    7iiesio-disto-occlusal    cavity    in 

bicuspid.  SSI.  !»1 

for  mesio  occlusal    cavity    in    bicus- 
pid, 89 

insert  and  cast  gold  inlay  for  me-io 
disto-labial-incisal  deficiency  in 
a  cent  ral.  291 


Task,  ideal  of  a.  -\<\ 
Tactile    sense,   31 
Tag-art,   1  I.". 

automatic  burner,  174 

automatic  investment   mixer,  168,  170 

automatic   wax  warmer.    }'•'•- 

casting  machine.  2nl.  2m.' 

flask   and   its  crucible  former,  204 

ijreen    wax.  ideal    for   inlay   work,   130 
Tait.  ::n| 
Teaching,  value  of  sequence  of  thought 

in,  21 

Technic   for  paralleling.  I'l'i'  -229 
Teeth,  adrenal.  375 

as  accessories  of  vocali/.at  ion.  52 

as  organs  of  incision,  52 

as  organs  of  mastication,  52 

as   organs  of  prehension,  52 

functions  of,  52 

geometric   landmarks   of.  i',.~. 

in    relation    to    organic    disease    and 
anomaly,  377 

loose,   splinting   bv    means   of   inlays, 
218-235 

pituitary,  .">7o 

stress  index  for  lower,  115 

stress  index  for  upper.  114 

thymic.  .".7.~i 

thyroidal.  -">7o 

Temperature  of  mold  for  casting.  1~S 
Temporomandibular   articulation,   247 
Tertiary  colors.  .">14 
Test  for  casting  machine,  205 
Thermal   shock,  elimination  of.  in  ca\i- 

ty  preparation,  126 
Thought,  sequence  of.  21 
Thymic   teeth,  ."i7o 
Thymodontia.  :;7.". 
Tliymo-pituito-adrenal  stress,  376 
Thymotrop.  ."."U 
Thymus.  W. 
Thyrojidrenal  tootli.  I'*!") 
Thyrodontia,  .'Ii'ii'i 
Thyroid  gland,  363 
Thyroidal  disbalance,  60 
Thyroidal  teeth.  ::7.~> 
Tilted  teeth,  separating.  330,  331 
Time  in  relation  of  life,  33 
Time  spent  in  mixing  compound,  167 
Tin  foil  burnished  on  models.  245 
Tissue   must   be  exercised,  55 
Toilet  of  the  cavity.  125 
Tooth    anatomy,    knowledge    of.    neces- 
sary to  inlay  worker.  15-' 
Tooth  surfaces  ami  angles.  6.1 
Touch,   sense  of,  32 
Tnule,   Dr.   Stanly.  :'..~>7 
Transparent  objects,  color  of,  311 


392 


1XDEX 


Traumatic   occlusion,  360 

Traumatic  origin  of  loss  of  occlusal  bal- 
ance, 241 

Tray,  compound-carrying,  338 

Trays  for  taking  impression,  344 

for  use  with  parallelodrill  in  splint- 
ing teeth,  229 

hinged,  for  taking  impressions  of  cav- 
ities, 144 

Trituration,  60 


TJ 


Undercuts  in  the  matrix,  355 
Unswaged  matrix,  advantage  of,  357 


Vacuum  machine  for  casting,  191 

a  pressure  machine,  194 
Van  Woert,  Dr.  F.  T.,  330,  332,  337 
Varnishing  of  model,   152 
Vasoauxiliary    functions    of    the    teeth, 

.58 

Vasomotor  force  in  relation  to  the  ad- 
renals, 371 

Vibration  in  relation  to  light,  303 
Vocalization,  teeth  as  accessories  of,  o2 
Vulcanite  splint,  making  and  finishing, 
248 

W 

Waller,  Ewan,  366 
Watts,  Marshall,  310 
Wave  theory  of  light,  303 
Wax  bite,  151 
Wax,  bleaching  of,  127 
composition  of,  127 


Wax— Cont  'd. 

forcing  into  cavity,  131 
impression   for   porcelain   inlay,   tak- 
ing the,  336 

for  porcelain  insert,  286,  295 
for  silicate  insert,  taking  of,   277, 

286 

use  of,  in  making  inlays  for  splint- 
ing teeth,  229 

inlay,  chilling  with  cold  water,  135 
for  compound  cavity,  135 
for  mesio-occluso-distal  cavity,  124 
instruments  for  making,  137 
making     and     carving,     by     direct 

method,  131 

making  of,  with  matrix,  136 
polishing  of,  134 
mineral,   128 

model,  burning  out  the,  173 
ozokerite,  128 
paraffine,    128 

pattern  invested  in  compound,  171 
requirements  for  inlay  work,  129 
selection  of,  127 
splint,  246,  248 
Taggart  green,  ideal  for  inlay  work, 

130 

warmer,  131,  132 
improvised,  134 
white,  128 
Weak  Hands,  37 
Wedgewood  mortar  ,149 
Welden,  Dr.  F.  S.,  357 
White  wax,  composition  of,  128 
Whitmell,  C.  T.,  312 
Wood,  304 


Young,  303 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 
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